CASE 12035 Published on 08.09.2014

Multiple pulmonary aneurysms in Behcet disease

Section

Chest imaging

Case Type

Clinical Cases

Authors

Lamhamedi S, Mennany M, Khnaba S, Ajana A, Gueddari FZ

Lamfadel Cherkaoui
10000 Rabat, Morocco;
Email: dr.l.safae@hotmail.com

Patient

50 years, male

Categories

Area of Interest Mediastinum, Thorax ; Imaging Technique CT

Procedure Diagnostic procedure ; Special Focus Aneurysms ;

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Clinical History

A 50-year-old man presented in the emergency department with a 5-month history of fever, weight loss (10 kg), dyspnoea and haemoptysis. The physical examination revealed a concomitant oral ulcer.

Imaging Findings

Contrast-enhanced chest CT revealed bilateral pulmonary aneurysms which were partially thrombosed (Fig. 1-3).

Discussion

Behçet's disease (BD) is a systemic vasculitis of unknown origin, first described in 1937.
The venous system is affected most, however, several cases of arterial aneurysms were reported in the literature [1-3].
The reported prevalence of pulmonary manifestations ranges from 1 to 7.7% [1].
Multisystem involvement is frequent and patients can have ophtalmological, neurological, vascular and dermatological manifestations [4].
CT-angiography is an excellent technique of diagnosis.
It is a non-invasive technique and allows the exploration of pulmonary arteries highlighting the aneurysmal dilatation and the thrombi in the lumen of these arterial aneurysms.
MRI and MRA offer the obvious advantage of multiplanar capability without the need for contrast injection [5].
Pulmonary arterial aneurysms are the leading cause of death in patients with Behçet's disease, however, pulmonary arterial aneurysms may completely resolve under immunosuppressive therapy [3].
The treatment is based on corticosteroids and endovascular treatment with coils [2].
Early detection of pulmonary artery aneurysm in the case of Behçet disease can save the patient's life [4].

Differential Diagnosis List

Pulmonary aneurysms with thrombosis in Behçet disease

Mycotic pseudoaneurysm

Traumatic pseudoaneurysm

Tumoural pseudoaneurysm

Final Diagnosis

Pulmonary aneurysms with thrombosis in Behçet disease

References

[1] Sonia Ketari, Besma Ben Dhaou, Zohra Aydi (2013) Pulmonary aneurysms in Behcet disease completely resolved after medical therapy. la tunisie médicale Vol 91 ( n°012 ) : 735-736 (PMID: 24458678)

[2] Kaouel K, Mechergui S, Ben Mrad I, Ben Mrad M, Meddeb I, Chaabene Z, Elleuch N, Gharbi M, Denguir R, Kalfat T, Khayati A. (2013) Endovascular treatment of an aneurysm of the abdominal aorta secondary to Behcet\'s disease. la tunisie médicale Vol 91 ( n°06 ) : 423 - 424 (PMID: 23868049)

[3] Adnan Agha*,1, Abdelhaleem M.E. Bella2 , Al-Hussain M. Assiri1 and Mohammad Al-Hakami1 (2011) Can Behcet’s Disease Related Pulmonary Arterial Aneurysms be Completely Resolved?. The Open Rheumatology Journal, 5, 88-90 (PMID: 22216070)

[4] Jayanth Doss, MDemailemail, James England, MD, Howard Fuchs, MD (2014) Coughing up Blood: Behçet\'s Disease. The American Journal of Medicine Volume 127, Issue 5, Pages 386–389 (PMID: 24576442)

[5] B Radouane, M Jidal, J El fenni, S Chaouir, T Amil, A Hanine, M BenAmeur Hôpital militaire (2008) Pulmonary artery aneurysms in Behçet\'s disease. eurorad Case 5744

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