대한흉부영상의학회 Weekly Chest Cases

Case No : 444 Date 2006-05-01

Courtesy of Eun Jeong Choi, MD, Yu Whan Oh, MD, Soo Yeon Ham, / Korea University Anam Hospital, Seoul, Korea
Age/Sex 40 / F
Chief Complaint Hemoptysis

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Diagnosis With Brief Discussion

Diagnosis: Pulmonary Artery Aneurysm Associated with Behcets Disease
Radiologic Findings: The patient was diagnosed as Behcet's disease 4 years ago. She came to the hospital due to hemoptysis. The chest PA shows ill defined opacity and a nodular opacity in right lower lung zone. On chest CT, there is a well defined round highly enhancing lesion with perilesional low density. The connection between this enhancing lesion and pulmonary artery was found on chest CT. During pulmonary arteriography, pulmonary arterial aneurysm was detected in the lateral basal segment of right lower lobe. Complete embolization using endovascular coils was performed. Postembolic angiographic image shows as belows.
Brief Review: Behcet's disease is a multisystem disorder characterized by vasculitis with triad; 1) recurrent oral ulcers 2) recurrent genital mucosal ulcers 3) relapsing uveitis. Involvement of other organs was reported, such as skin, CNS, GI, lung, vessels, kidney, musculoskeletal system, etc.

Pulmonary problems can be classified into three groups as follows; 1) pulmonary artery aneurysm, 2) parenchymal changes, 3) a miscellany including pulmonary artery occlusion, pleural effusion, and pulmonary obstructive airway disease. Pulmonary artery aneurysm is the most common type of pulmonary involvement in Behcet's disease, and induces hemoptysis. It can be single or multiple, unilateral or bilateral, true or false, and can be complicated by bronchopulmonary artery fistulas. Possibility of other large extrapulmonary vessel lesions is increased when there is pulmonary artery aneurysm
References: 1. Thoracic Involvement in Behcet뭩 Disease and Its Correlation with Multiple Parameters. Lung 2000; 178:161?70

2. Pulmonary Vasculitis in Beh?t Disease: A Cumulative Analysis. Chest 2005;127;2243-2253
Keywords: Vascular, Vascular, Behcet's disease,

No. of Applicants : 46

▶ Correct Answer : 19/46, 41.3%

- Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
- Hopital Calmette CHRU, Lille, France Toledano Manuel
- Pusan National University Hospital, Korea Kun-Il Kim
- National Taiwan University Hospital, Taiwan Yu-Feng Wei
- Annecy Hospital, France Gilles Genin
- Zulekha Hospital, Dubai Saurabh Khandelwal
- Maimonides Medical Center; Brooklyn, New York, USA Naomi Twersky
- Kosin University Gospel Hospital, Korea Mi Hee Jung
- Samsung Medical Center, Seoul. Dae Kun Oh
- Cabinet de Radiologie Guiton, La Rochelle, France Jean-Luc Bigot
- Monaldi Hospital, Naples, Italy Gaetano Rea
- Sam Anyang Hospital, Korea Jae Seung Seo
- Hangang Sacred Heart Hospital, Korea Eil Seong Lee
- Radiologie Guiton, La Rochelle, France Denis Chabassiere
- Samsung medical center, Seoul, Korea Ha Young Kim
- Annemasse, Polyclinique de Savoie, France Gay-Depassier
- Diskapi Yildirim Beyazit Hospital, Ankara, Turkey Meric Tuzun
- China Medical University Hospital,Taiwan Jun-Jun Yeh
- Yonsei University Shinchon Severance Hospital, Korea Hye-Jeong Lee

▶ Correct Answer as Differential Diagnosis : 2/46, 4.3%

- Regional Imaging-Riverina, Australia Rashid Hashmi
- Ondokuz Mayis University, Samsun, Turkey Cetin Celenk

▶ Semi-Correct Answer : 7/46, 15.2%

- Kangdong SacredHeart Hospital, Korea Kyoung Ja Lim
- Pgimer, Chandigarh, India Ram Prakash Galwa
- Cape Breton Regional Hospital, Canada M U Islam
- Nirman Hi-tech Diagnostic Center, Mumbai, India Minal Seth
- Yonsei University Shinchon Severance Hospital, Korea Eun Hye Yoo
- Yamaguchi Red Cross Hospital, Japan Kouei Uchida
- Max Hospital, New Delhi, India Vickrant Malhotra

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 444 Date 2006-05-01

Discussion

No. of Applicants : 46