Pulmonary involvement in Behcet disease

Pulmonary vasculitis: diagnosis and endovascular therapy

Pulmonary vasculitides are caused by a heterogeneous group of diseases with different clinical features and etiologies. Radiologic manifestations depend on the predominant type of vessel involved, which are grouped into large, medium, or small-sized vessels. Diagnosing pulmonary vasculitides is a challenging task, and radiologists play an important role in their management by providing supportive evidence for diagnosis and opportunities for minimally invasive therapy. This paper aims to present a practical approach for understanding the vasculitides that can affect the pulmonary vessels and lungs. We will describe and illustrate the main radiologic findings, discussing opportunities for minimally invasive treatment.

Imaging manifestations of Behcet's disease: Key considerations and major features

Behcet's disease is an autoimmune disease most commonly seen in the Middle East. Although primarily known with painful oral and genital ulcers, it can lead to vasculitis. Therefore, several associated complications such as thrombotic syndromes, aneurysmal arterial disease may arise. In many cases, it might be difficult to make the diagnosis purely based on clinical grounds; however, imaging plays an important role for both diagnosis and assessment of the disease's complications. We provide a comprehensive review of the most notable imaging findings of Behcet's disease.

Femoral Artery Aneurysms In Behçet's Disease

Vascular involvement in Behçet's disease (BD) can include both arteries and veins. Arterial aneurysms in BD have been seen most commonly at the abdominal aorta and femoral arteries. During a seven-year period, 7 aneurysms in 5 patients were surgically treated in the authors' department. Arteriography was performed in the first 2 patients for diagnosis. Pseudoaneurysms occurred at puncture sites in these patients. All patients were treated surgically with saphenous or polytetrafluoroethylene grafts. One patient died of rupture of an abdominal aortic aneurysm. Another patient had above-knee amputation because of the graft's pseudoaneurysm, late septic embolus, and necrosis of the extremity.

Pulmonary Vasculitis: Spectrum of Imaging Appearances

Pulmonary vasculitis is a relatively uncommon disorder, usually manifesting as part of systemic vasculitis. Imaging, specifically computed tomography, is often performed in the initial diagnostic workup. Although the findings in vasculitis can be nonspecific, they can provide important clues in the diagnosis, and guide the clinical team toward the right diagnosis. Radiologists must have knowledge of common and uncommon imaging findings in various vasculitides. Also, radiologists should be able to integrate the clinical presentation and laboratory test findings together with imaging features, so as to provide a meaningful differential diagnosis.

Hughes-stovin syndrome and massive hemoptysis: a management challenge

Hughes-Stovin syndrome is a very rare clinical entity characterized by pulmonary artery aneurysms and deep vein thrombosis (DVT). Here we report the case of a 53-year-old man, admitted to Sultan Qaboos University Hospital, Muscat, Oman, with bilateral pulmonary artery aneurysms and lower-limb DVT who developed massive hemoptysis. He was managed successfully with high-dose steroids in combination with cyclophosphamide.

Pulmonary artery involvement and associated lung disease in Behçet disease: a series of 47 patients

Pulmonary artery aneurysms (PAAs) are well known causes of mortality and morbidity in Behçet disease (BD). However, pulmonary artery involvement in BD is not limited to PAA; the other main type of pulmonary artery involvement is pulmonary artery thrombus (PAT), with or without associated PAA. In addition, other types of lung disease like nodules and cavities in the lung parenchyma are frequently associated with pulmonary artery involvement, and can be misinterpreted as being due to infection. We surveyed the clinical, radiologic, and laboratory characteristics and outcome of 47 BD patients with pulmonary artery involvement and the associated findings, all seen and followed at a single dedicated tertiary care center.We identified 47 (41 male, 6 female) patients in whom pulmonary artery involvement was diagnosed, who were registered in the multidisciplinary clinic at Cerrahpasa Medical Faculty between January 2000 and December 2007. Mean age at diagnosis was 29 ± 8 years, and mean disease duration to the onset of pulmonary artery involvement was 3.6 ± 4.8 years. Hemoptysis was the most common presenting symptom (79%) followed by cough, fever, dyspnea, and pleuritic chest pain. Thirty-four of 47 patients (72%) presented with PAA, including 8 with associated PAT. The remaining 13 patients (28%) had isolated PAT. Patients with isolated PAT in general have clinical features similar to patients with PAA. However, hemoptysis was less frequent and voluminous in patients with isolated PAT. Most (91%) of the patients had active disease outside the lungs when they presented with pulmonary artery involvement.Forty (85%) patients had nodules and 6 (13%) had cavities when first seen. Peripheral venous thrombosis was present in 36 of 47 (77%) patients, and intracardiac thrombi in 12 of the 36 (33%) patients. Nodules, cavities, and intracardiac thrombi were mainly present in the acute stages of pulmonary artery involvement.Pulmonary artery involvement is usually multiple, and involves mostly descending branches of the pulmonary artery. Pulmonary artery involvement may disappear, but arterial stenosis or occlusions usually develop at the same location. After a mean follow-up of 7 years, 12 of 47 (26%) patients were dead; patients with larger aneurysms were more likely to die. Sixteen of 47 (34%) patients were symptom free, and the remaining 40% had mild dyspnea (13/47) and/or small bouts of hemoptysis (8/47).Pulmonary artery pressure may be elevated, and may indicate a poor prognosis. Mediastinal lymphadenopathy and mild pleural and pericardial effusions may also be observed. Corticosteroids and immunosuppressive agents are the mainstays of treatment; however, refractory cases may require embolization, lobectomy, cavitectomy, and decortication.

Hughes-Stovin syndrome

Hughes-Stovin Syndrome (HSS) is a very rare clinical disorder characterized by thrombophlebitis and multiple pulmonary and/or bronchial aneurysms. Less than 40 published cases of HSS have been described in English medical literature so far. The exact etiology and pathogenesis of HSS is unknown; possible causes include infections and angiodysplasia. HSS has also been considered as a variant of Behcet's disease (BD). Patients with HSS usually present with cough, dyspnea, fever, chest pain and haemoptysis. The management of HSS can either be medical or surgical. Medical management includes the use of steroids and cytotoxic agents. Cyclophosphamide, in particular, is a favored therapeutic agent in this regard. Antibiotics have no proven role in HSS while anticoagulants and thombolytic agents are generally contraindicated due to an increased risk of fatal hemorrhage. However, their use may be considered with great care under special circumstances, for instance, intracardiac thrombi or massive pulmonary embolism. For cases of massive hemoptysis due to large pulmonary aneurysms or those with lesions confined to one segment or one lung, lobectomy or pneumectomy can be carried out. However, surgical risks merit serious consideration and must be discussed with the patient. Transcatheter arterial embolization has emerged as a less invasive alternative to surgery in selected cases of HSS. Overall, patients with HSS have a poor prognosis and aneurysmal rupture is the leading cause of death. However, early diagnosis and timely intervention is crucial in improving the prognosis. There is a need to clearly elucidate the genetic, etiologic and pathologic basis for HSS in the future. Although most of the evidence put forward to refute the role of an infectious agent in the etiology and pathogenesis of HSS is based on negative blood and other body fluid cultures, more robust objective assessment is needed through the use of electron microscopy or 16 sRNA studies. The development of better therapeutic agents is also needed to address and prevent the serious consequences arising from pulmonary arterial aneurysms seen in BD and HSS. Also, the issue of anticoagulation in these patients is challenging and requires further deliberation.

Mortality in Behçet's disease

OBJECTIVE

To report the long-term mortality in patients with Behçet's disease (BD).

METHODS

A cohort of 817 patients fulfilling the international criteria for BD from a single center in France were analyzed for causes of death, the standardized mortality ratio (SMR), and the factors associated with mortality.

RESULTS

Among the 817 patients with BD, 41 (5%) died after a median followup of 7.7 years, of whom 95.1% were male. The mean ± SD age at death was 34.8 ± 11.9 years. Main causes of death included major vessel disease (mainly, arterial aneurysm and Budd-Chiari syndrome) (43.9%), cancer and malignant hemopathy (14.6%), central nervous system involvement (12.2%), and sepsis (12.2%). The mortality rate at 1 year and 5 years was 1.2% and 3.3%, respectively. There was an increased mortality among patients ages 15-24 years (SMR 2.99, 95% confidence interval [95% CI] 1.54-5.39) and those ages 25-34 years (SMR 2.90, 95% CI 1.80-4.49) as compared with age-and sex-matched healthy controls. The mortality decreased in patients older than age 35 years (SMR 1.23, 95% CI 0.75-1.92). In multivariate analyses, male sex (hazard ratio [HR] 4.94, 95% CI 1.53-16.43), arterial involvement (HR 2.51, 95% CI 1.07-5.90), and a high number of BD flares (HR 2.37, 95% CI 1.09-5.14) were independently associated with the risk of mortality.

CONCLUSION

The overall mortality in our BD cohort was 5% after a median followup of 7.7 years. Male sex, arterial involvement, and the number of flares were associated with mortality in BD.

Imaging of pulmonary vasculitis

The presence of pulmonary vasculitis can be suggested by a clinical presentation that includes diffuse pulmonary hemorrhage, acute glomerulonephritis, chronic refractory sinusitis or rhinorrhea, imaging findings of nodules or cavities, mononeuritis multiplex, multisystemic disease, and palpable purpura. Serologic tests, including the use of cytoplasmic antineutrophil cytoplasmic antibody (ANCA) and perinuclear ANCA, are performed for the differential diagnosis of the diseases. A positive cytoplasmic ANCA test result is specific enough to make a diagnosis of ANCA-associated granulomatous vasculitis if the clinical features are typical. Perinuclear ANCA positivity raises the possibility of Churg-Strauss syndrome or microscopic polyangiitis. Imaging findings of pulmonary vasculitis are diverse and often poorly specific. The use of a pattern-based approach to the imaging findings may help narrow the differential diagnosis of various pulmonary vasculitides. Integration of clinical, laboratory, and imaging findings is mandatory for making a reasonably specific diagnosis.

The clinical feature of Behçet's disease in Northeastern China

PURPOSE

Behçet's disease (BD) is a chronic, relapsing, multi-system vasculitis of unknown aetiology with complicated and diversified clinical features predominantly involving oral and genital ulcers, and ocular and cutaneous lesions. The clinical features of this disease have been described to be different according to geographical areas and gender. We investigated the specific clinical features of BD patients in Northeastern China.

MATERIALS AND METHODS

116 patients involved in this study fulfilled the classification criteria of the International Study Group for BD. The clinical manifestations and results of laboratory tests of BD were recorded in each patient.

RESULTS

The onset was typically between 20-39 years with a slight female predominance. Oral ulcers were the most common manifestation, followed by skin lesions, positive pathergy reaction/genital ulcers, and ocular lesions. Vascular lesion and epididymitis were rare in patients with BD. The frequency of erythema nodosum-like lesion and articular involvement were significantly higher in females, while gastrointestinal involvement was significantly higher in males. The results of laboratory tests showed that the human leukocyte antigen (HLA)-B*51 alleles were positive in 30.9% of patients and the immunological abnormities were present in some patients.

CONCLUSION

The clinical features of BD showed geographical and gender difference. Genetic and immune factors might participate in aetiopathogenesis of BD.

Pulmonary alterations in Behcet's disease

PURPOSE

This study aims to demonstrate pulmonary alterations (PA) in patients with Behcet's disease by using CT.

MATERIALS AND METHODS

CTs of 50 patients with Behcet's disease and 20 others in a control group have been evaluated retrospectively for PA (septal, reticular, nodular, atelectatic opacities).

RESULTS

Eight out of 50 patients (16%) with Behcet's disease showed PA. Three out of 20 (15%) in the control group showed PA. No differences were observed between Behcet's disease patients and the control group regarding pulmonary alterations (p=0.917). No differences were observed in the disease duration, ages and sex in either group in those with and without PA.

CONCLUSION

Pulmonary alterations can be seen in patients with Behcet's disease, but these alterations are not significant.

Collagen Vascular Diseases and Disorders of Connective Tissue

The collagen vascular diseases, also referred to as connective tissue diseases, are a diverse group of systemic inflammatory disorders thought to be immunologically mediated. The concept of collagen vascular disease began to take shape in the 1930s, when it was recognized that rheumatic fever and rheumatoid arthritis can affect connective tissues throughout the body.1,2 During the following decade, as conditions such as systemic lupus erythematosus (SLE) and scleroderma came to be viewed as systemic diseases of connective tissue, the terms diffuse connective disease and diffuse collagen disease were proposed.3,4 During the same period, the designation of diffuse vascular disease was proposed for diseases such as scleroderma, polymyositis, SLE, and polyarteritis nodosa, which featured widespread vascular involvement.5 With the realization that many of these entities can exhibit both systemic connective tissue manifestations and vascular abnormalities, the unifying designation of collagen vascular disease was introduced.6

Hughes–Stovin syndrome: is it incomplete Behçet’s?

In this report, we described two male patients with Hughes-Stovin syndrome. The first patient was a 26-year-old male who initially presented with deep vein thrombosis (DVT) in the right lower limb followed shortly by hemoptysis. Pulmonary CT angiography revealed bilateral pulmonary artery aneurysms secondary to underlying pulmonary vasculitis. While the second case was a 16-year-old male patient who initially presented with generalized fits due to sagittal sinus thrombosis and later followed by DVT in the left lower limb. Pulmonary CT angiography showed small pulmonary artery aneurysms with thrombosis of peripheral pulmonary artery branches. Both patients were treated successfully with steroids and immunosuppressive therapy and showed clinical improvement.

Transformation of a ruptured giant pulmonary artery aneurysm into an air cavity after transcatheter embolization in a Behçet's patient

Pulmonary artery aneurysms due to Behçet's disease are mainly seen in young males and very rarely in females. To our knowledge there are only 10 cases reported in the related literature. Emergent transcatheter embolization was performed in a female patient with a known history of Behçet's disease in whom massive hemoptysis developed because of rupture of a giant pulmonary artery aneurysm. At 6-month follow-up, transformation of the aneurysm sac into an air cavity was detected. To our knowledge, such a transformation has never been reported in the literature before. Embolization of the pulmonary artery aneurysm and the mechanism of cavity transformation are reviewed and discussed.

Pulmonary vasculitis in behcet disease: a cumulative analysis

STUDY OBJECTIVES

The aims of this study were to investigate the frequency of pulmonary problems in Behçet disease (BD), and to discuss lesser-known features of pulmonary BD such as clinical characteristics, analysis of prognosis, and evaluation of treatment options with respect to the previously published cases.

DESIGN

We conducted a comprehensive review of the literature to analyze cumulated data about pulmonary involvement in BD.

SETTING

We found 159 articles regarding pulmonary disease associated with BD in May 2003.

PATIENTS

The evaluation of these articles demonstrated 598 pulmonary problems in 585 cases.

RESULTS

Pulmonary artery aneurysms (PAAs) are the most common pulmonary lesion in BD, and these are almost always associated with hemoptysis. Seventy-eight percent of patients with aneurysms have concomitant extrapulmonary venous thrombi or thrombophlebitis. Other pulmonary problems are reported in BD, and these are principally related to vascular lesions and radiologic abnormalities.

CONCLUSIONS

Pulmonary vascular problems, either PAA or involvement of small-sized vessels, are the main pulmonary disorders in BD. Immunopathologic findings indicate that the underlying pathogenesis is pulmonary vasculitis, which may result in thrombosis, infarction, hemorrhage, and PAA formation. Patients with small nonspecific radiologic abnormalities should be followed up closely since early diagnosis of vascular lesions may be life-saving. Immunosuppression is the main therapy for the treatment of a vasculitis. It is important that pulmonary angiitis is not mistaken for pulmonary thromboembolic disease since fatalities have occurred in BD shortly after initiation of anticoagulation/thrombolytic treatment.

Angio-Behçet with vertebral erosion: an exceptional Behçet’s complication and literature review

Behçet's disease is a multisystem disorder commonly seen in Japan and in Mediterranean countries characterized by a vasculitis of unknown origin. In this work, we describe a case of a 47-year-old man with Behçet's disease of 28 years evolution who presented with a common lumbago and revealed to have a rare case of destruction of the third lumbar vertebra due to a giant pseudoaneurysm of the right iliac artery. In the discussion, we make a brief review of the literature on the subject and analyze the existence of three similar cases.

Thoracic Manifestations of Behçet Disease at CT

Behçet disease is a multisystemic and chronic inflammatory disorder of unknown cause that is characterized by recurrent oral and genital ulcerations, ocular manifestations, and additional clinical manifestations in multiple organ systems. Behçet disease involving the chest can manifest as a wide spectrum of abnormalities. Although conventional chest radiography is commonly used for initial assessment, spiral computed tomography can demonstrate the entire spectrum of thoracic manifestations of Behçet disease, including abnormalities of the vessel lumen and wall, perivascular tissues, lung parenchyma, pleura, and mediastinal structures. Aneurysms of the pulmonary arteries, with or without thrombosis, are a typical manifestation of Behçet disease. Other manifestations include thrombosis, vasculitis, hemorrhage, infarction, and inflammation. Familiarity with these manifestations can be useful in the diagnosis of Behçet disease, helping to determine the cause of symptoms in patients who present with hemoptysis and guide the choice of appropriate therapy.

Pulmonary complications of Behçet's disease

Our knowledge about pulmonary complications of Behçet's disease continues to evolve, but we need controlled trials for the management of the disease. The main goal should be to elucidate the pathogenesis and standardize the management according to the underlying pathologic process.

99Tcm-MAA lung scintigraphy in patients with Behçet's disease: its value and correlation with clinical course and other diagnostic modalities

Behçet's disease, initially described as local vasculitis involving the oral, genital mucosa and eyes, can affect many organ systems with a varying clinical course. Pulmonary lesions associated with Behçet's disease are rare and reported to have a prevalence of 1.0-7.7%. In this prospective study, 29 patients aged 16-60 years (mean +/- s: 34 +/- 10.5) were investigated for pulmonary involvement with direct radiography, computerized tomography (CT) and intravenous digital subtraction angiography. Lung scintigraphy was also performed to determine its diagnostic value. In addition, patients had a fibreoptic bronchoscopic examination, spirometric test, carbon monoxide diffusion test and methacholine test. Of the 29 patients with Behçet's disease, 17 had pulmonary involvement. The diagnostic criteria for pulmonary vasculitis and tracheobronchial tree involvement were: (1) hilar vascular prominence or mass, new alveolar and reticulonodular infiltrates on chest X-ray; (2) aphthous lesions, bleeding ulcerations, inflamed mucosal appearance on bronchoscopy; (3) vascular thrombosis or aneurysms on CT; (4) occlusion or aneurysms of the main pulmonary arteries or its branches. The value of lung scintigraphy and its correlation with other imaging modalities were investigated to determine if a lung perfusion scan alone can be used to detect pulmonary involvement in Behçet's disease. Twenty-six patients were investigated with lung scintigraphy. Thirteen of 14 patients with lung involvement were identified. Perfusion lung scintigraphy provided true diagnostic information in 96% of our patients. In eight patients without pulmonary involvement, the lung scans were normal. Although DSA specifically demonstrates pulmonary aneurysms, it involves administration of contrast media and cannot show abnormalities distal to the third pulmonary arterial branches. Although vasculitis caused by collagen disorders is physiologically indistinguishable from pulmonary emboli, most perfusion defects resolve within 3 months, which can be used as a differential diagnostic criterion in the appropriate clinical setting. Therefore, pulmonary perfusion imaging can be used to screen patients suspected of having lung involvement, especially in the absence of thrombophlebitis. In patients with thrombophlebitis, a repeat examination at 3 months is recommended to differentiate pulmonary involvement from pulmonary embolism.

Behçet's disease and complex aphthosis

Behçet's disease is a complex multisystem disease diagnosed by means of clinical criteria. Clinical features include oral and genital aphthae, pustular vasculitic cutaneous lesions, and ocular, gastrointestinal, and vascular manifestations. We believe that complex aphthosis, characterized by oral or oral and genital ulcers, may be a forme fruste of Behçet's disease. Although the pathogenesis of both Behçet's disease and complex aphthosis remain unknown, immune factors, infectious agents, and effector mechanisms are implicated. Treatment is based on the severity of systemic involvement and includes topical therapies as well as colchicine, dapsone, thalidomide, and immunosuppressive agents.

Pulmonary vasculitis

Pulmonary vascular inflammation may be seen in a variety of primary lung diseases and in the setting of numerous systemic illnesses. This article reviews those entities in which pulmonary vasculitis represents a central feature of the pathologic process (Wegener's granulomatosis, Churg-Strauss syndrome, and pulmonary capillaritis). In addition, features of pulmonary involvement in other systemic vasculitides (Giant Cell Arteritis, Takayasu's Arteritis, and Behçet's disease) are described. Finally, general principles for the treatment of vasculitis are reviewed.

MR angiography of aneurysms in Behçet disease: a report of four cases

PURPOSE

The purpose of this study was to evaluate the use of MR angiography (MRA) in Behçet disease patients with arterial aneurysms. Avoidance of angiography is desirable in patients with Behçet disease because arterial angiography carries the risk of pseudoaneurysm formation at the puncture site and intravenous digital subtraction angiography is frequently complicated by puncture site thrombophlebitis in this patient group.

METHOD

Four men with Behçet disease and aneurysms were evaluated with MRA. The patients ranged between 30 and 48 years of age. All subjects had known Behçet disease for > 10 years. Multiplanar T1-weighted images were followed by 2D breath-hold MRA without gadolinium administration for chest studies and 2D-TOF MRA for the extremities.

RESULTS

One aortic arch, one descending aorta, one pulmonary artery, one common femoral artery, and one popliteal artery aneurysm were depicted in four subjects with MRA. Surgery was successfully performed in three subjects without the need for further angiographic workup. One subject with two aneurysms in the thoracic aorta is currently under steroid treatment.

CONCLUSION

MRA combined with T1-weighted SE images adequately demonstrated the aneurysms in four patients and made it possible to avoid contrast angiography.

Right atrial thrombus mimicking myxoma and bilateral pulmonary artery aneurysms in a patient with Behçet's disease--a case report

A case of Behçet's disease, in which superior vena cava syndrome was the presenting feature is reported. Magnetic resonance imaging and echocardiography revealed a mass lesion in the right atrium. This patient developed bilateral pulmonary artery aneurysms postoperatively and represents one of the bizarre manifestations of Behçet's disease.

Behçet's disease presenting with a pulmonary mass lesion

We report a case of Behçet's disease with pulmonary and splenic involvement. The radiologic presentation was quite different from the modes defined in the literature. A large, anteriorly located, well circumscribed ovoid mass was the x-ray film image of a large area of infarction with hemorrhage. The involved pulmonary artery showed signs of vasculitis with thrombus formation. To our knowledge, this mode of presentation is different from the cases reported in the literature.

Rare rheumatic disorders. A. Behçet's disease

No more than 100 patients with respiratory involvement in Behçet's disease have been described in the literature. Haemoptysis, cough, dyspnoea and pleuritic chest pain are the main symptoms. Vasculitis and thrombosis of the great pulmonary vessels is the underlying condition in the majority of patients. Aneurysmal formation and rupture is possible and constitutes the most life-threatening aspect of the disease. Behçet's syndrome should be considered in the differential diagnosis of haemoptysis and veno-occlusive disease, especially where large vessels are involved. Early detection and treatment is mandatory to save the patient's life. Other pleuropulmonary manifestations described, such as fibrosing alveolitis and pleural disease, occur less frequently in Behçet's disease, and carry a better prognosis.

Cyclosporin treatment in rapidly progressive pulmonary thromboembolic Behçet's disease

A patient with Behçet's disease with pulmonary thromboemboli responded to treatment with cyclosporin A and coumarin.

Pulmonary arterial occlusions and aneurysms: a forme fruste of Behçet's or Hughes-Stovin syndrome

A patient is reported with pulmonary arterial occlusions and aneurysms and recurrent haemoptysis. He gave a history of recurrent arthropathy and febrile illnesses; though he had had no other features of Behçet's or Hughes-Stovin syndrome his disease probably fell into this broad diagnostic category.

Pulmonary involvement in Behçet's syndrome

We present a case of Behcet's syndrome with unusual pulmonary manifestations. A woman presented five years previously with oral, genital and ocular lesions found on biopsy to be consistent with Behcet's syndrome. While on prednisolone, she complained of nonpleuritic chest pain. Clinical features of active Behcet's syndrome were absent. A previously normal chest x-ray film showed multiple intrapulmonary lesions. Laboratory abnormalities were consistent with findings seen in phases of disease activity. Bronchoscopy showed ulceration of the bronchial mucosa, but no evidence of opportunistic infection or neoplasia. Pulmonary angiography excluded vaso-occlusive abnormalities. A provisional diagnosis of pulmonary involvement with Behcet's syndrome was made and the patient responded to further immunosuppressive therapy.

Pulmonary manifestations in Behçet's syndrome

Among 72 patients with Behçet's syndrome, seven had pulmonary vascular involvement. Additional data from 42 cases in the literature are discussed. Recurrent episodes of dyspnea, cough, chest pain, and hemoptysis were the primary clinical signs, mainly in young men, appearing 3.6 years after the first manifestation of Behçet's syndrome. Fever, elevated ESR, and anemia were common, and chest x-ray films showed pulmonary infiltrates, pleural effusions, and prominent pulmonary arteries. Ventilation-perfusion scans showed perfusion defects even when chest x-ray films were normal. Pulmonary artery aneurysms were seen in 7/13 in whom angiography was done. Of 42 patients, 16 died, 15 from fatal pulmonary hemorrhage, 80 percent within two years from the development of pulmonary disease. Histopathologic study results showed vasculitis of pulmonary vessels of various sizes, leading to thrombosis, destruction of the elastic laminae, aneurysms, and arteriobronchial fistula. In addition, pulmonary emboli and the aphthous lesion of the tracheobronchial tree may aid the clinical picture. Anticoagulant therapy may be hazardous in patients with aneurysmal dilatation of the pulmonary vascular tree, and the beneficial effect of corticosteroid therapy is discussed. Pulmonary vasculitis in Behçet's syndrome is a unique clinical and pathologic picture, differing from other vasculitides affecting the lung, presents a major threat to the patient's life.

Cardiac and pulmonary manifestations of Behçet syndrome

Behçet syndrome is a systemic disease rather than the initial more narrowly characterized triple symptom-complex of recurrent oral and genital ulcers and chronic iridocyclitis. Major cardiac and pulmonary manifestations of the disease are relatively uncommon and their pathologic features have seldom been documented. Described herein is a fatal case of Behçet syndrome with co-existing myocarditis, pulmonary thromboangiitis, and pulmonary artery aneurysms.

Massive hemoptysis complicating Behçet's syndrome: the importance of early pulmonary angiography and operation

A 16-year-old patient with Behçet's syndrome had massive hemoptysis due to a ruptured aneurysm of a segmental artery of the left lung. Emergency left lower lobectomy was performed. The patient is well 12 months after operation. There have been no further episodes of hemoptysis.

Multiple pulmonary artery aneurysms. New use for magnetic resonance imaging

The first patient in whom multiple pulmonary artery aneurysms were detected by magnetic resonance imaging is described. The patient was successfully treated with surgery.