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Weekly Chest CasesArchive of Old Cases

Case No : 688 Date 2011-01-03

  • Courtesy of Ji Eun Park, Sung Shine Shim, Yookyung Kim / Mok Dong Hospital, Ewha Womans University
  • Age/Sex 53 / M
  • Chief ComplaintFever, cough with hemoptysis for 1 week
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Behcet's disease
Radiologic Findings
On CT scan, airspace consolidation in right lung subpleural area and dilation of right interlobar artery with thrombus are noted. There is a well defined round highly enhancing lesion with perilesional low density. The connection between this enhancing lesion and pulmonary artery is found.
Brief Review
Behcet disease is a rare systemic large and small vessel vasculitis likely due to deposition of immune complexes. The clinical triad of recurrent oral and genital ulcerations and uveitis, as well as skin lesions and positive skin pathergy test are key factors in diagnosis.
Pulmonary involvement is relatively infrequent, have been reported 5% to 10% of cases. Aneurysms of the pulmonary arteries, otherwise an uncommon entity, are a typical manifestation of Behcet disease. In fact, Behcet disease is the most common cause of pulmonary artery aneurysm. Other pulmonary manifestations include thrombosis of the superior vena cava and/or other mediastinal veins, pleural effusion, mediastinal or hilar lymphadenopathy, and rarely, myocardial or pericardial involvement.
Pulmonary artery thrombosis as in this case may be associated with focal pulmonary hemorrhage. Hemoptysis may occur due to leakage or rupture of an aneurysm and may be life threatening. Therefore, aneurysm formation in the pulmonary arteries indicates a poor prognosis.
No randomized controlled studies have evaluated treatment options for pulmonary vasculitis with Behcet disease. Colchicine has been recommended as a basic treatment, but a recent controlled trial has again confirmed that this pharmacotherapy is only effective relieving erythema nodosum and urogenital ulceration. Various treatment modalities in pulmonary aneurysm include imunosuppressive drugs alone or in combination with steroids, surgery, and endovascular embolization. In case of massive hemoptysis, surgery or endovascular embolization is necessary. To avoid pulmonary amputation, aneurysmectomy or occlusion of the arterial defect by direct suture was applied.
References
1. Makoto T, Ryoji Y, Ryu N. Successful surgical treatment of pulmonary artery aneurysm in Behcet’s syndrome. Interact CardioVasc Thorac Surg 2009;8:390-392
2. Naim C, Selen B, Sikru M, Recep S, Hudaver A. Pulmonary and vascular manifestations of Behcet disease: imaging findings. AJR 2010;194:158-164
3. Nurith H, Sivan L, Tova C, Jacob B, Dorith S. Thoracic manifestations of Behcet disease at CT. Radiographics 2004;24:801-808
4. Richard W. Charles H. Behcet’s disease. Thoracic imaging 2nd edition 2010; 522-524
Keywords
Vascular, Vasculitis, Behcet's disease,

No. of Applicants : 119

▶ Correct Answer : 29/119,  24.4%
  • - SMC , Korea (South) Jihoon Cha
  • - Hangang sacred heart hospital , Korea (South) You Mie Han
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - chonnam university hospital , Korea (South) shin hyo hyun
  • - Univ. of Miami/Jackson Memorial , United States mantosh rattan
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Okayama University , Japan Akihiro Tada
  • - Chonnam university hospital , Korea (South) Minyoung Jung
  • - Sunchun university hospital, Bucheon , Korea (South) So Young Bae
  • - Youngdong Hospital , Korea (South) Sang Min Lee
  • - radiologist, aditya imaging centre , India vivek patel
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Songtan public health center, Goduk substation , Korea (South) Jaewang Shin
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
  • - TRAKYA UNERSEST FAKULTES><br> <input type=hidden name=id27277 value= , Turkey CAGLAYAN CAKIR
  • - SNUH , Korea (South) Eun LEE
  • - Bundang CHA hospital , Korea (South) Jung Jin Young
  • - chp st martin , France Mariotte benoit
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Radiology , Korea (South) YOONAH SONG
  • - Kobe City Medical Center General Hospital , Japan Junko Ochi
  • - Hotel-Dieu Montreal , Canada nicolas gautier
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Seoul Nationial University Bundang Hospital , Korea (South) Hee Seok Choi
  • - UZ GASTHUISBERG , Belgium Johan COOLEN
  • - Saga University , Japan Ryoko Egashira
▶ Correct Answer as Differential Diagnosis : 68/119,  57.1%
  • - Catholic medical center , Korea (South) hyuna kim
  • - KMC,Manipal , India satish maddukuri
  • - seoul national university hospital , Korea (South) Ijin Joo
  • - kobe city general hospital , Japan rintaro hashimoto
  • - NDMVP Nashik , India Imran Jindani
  • - Inha University Hospital , Korea (South) Ju Won Lee
  • - Retd. Prof Thoracic Surgery B.J.MEDIDCAL COLLEGE Punr India;Visitng Prof of Thoracic Surgery KLE University Belgaum , India Bankim Amin
  • - Montreal , Canada D J
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Seoul National University Hospital , Korea (South) Hyun Ju Lee
  • - CHRU lille , France manuel toledano
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Gifu Chuo Hospital , Japan Yo Kaneko
  • - Hopital Louis Pradel , France Clent Proust
  • - Iwate medical university , Japan Akio Akahane
  • - Auckland hospital , New Zealand (Aotearoa) Yuranga Weerakkody
  • - Dongnam Institute of Radiological and Medical Sciences , Korea (South) Dae Wook Yeh
  • - Kobe City Medical Center General Hospital , Japan Hitomi Nagano
  • - McGill , Canada Marcus Povitz
  • - McGill University , Canada Ben Smith
  • - chest hospital , India k bhaskar
  • - Chonnam National University Hospital , Korea (South) Jung Hyun Kim
  • - Chonnam national university hospital , Korea (South) SeungJin Lee
  • - Chonnam university hospital , Korea (South) LEE JI HYUN
  • - CNUH , Korea (South) Hyedoo Jung
  • - Yonsei University College of Medicine, Shinchon Severance hospital , Korea (South) Young Joo Suh
  • - Chonnam national university hospital , Korea (South) Jang-hyeon Song
  • - CNUH , Korea (South) Seoin Jeong
  • - Chonnam national university hospital , Korea (South) Yunhong Yoon
  • - Chonnam national univ. hospital , Korea (South) Choi Seul Gi
  • - Department of Radiology, Chonnam National University Hospital , Korea (South) Hyungjun Kim
  • - chonnam national university , Korea (South) Byung Hyun Baek
  • - Chonnam national university hospital , Korea (South) Hyeong wook Kim
  • - CHA Bundang hospital , Korea (South) Hyerin Kim
  • - Kangnam Sacred Heart Hospital , Korea (South) Jaewon Kim
  • - Chonnam National University Hospital , Korea (South) Daun Lee
  • - ROK air force aerospacemedical center , Korea (South) Daekeon Lim
  • - McGill University Health Center , Canada Alexandre Semionov
  • - NTUH , Taiwan Kuei-pin Chung
  • - Virgin Mary Hospital Burgas , Bulgaria VLADISLAV RUSINOV
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - KING KHALID UNIVERSITY HOSPITAL , Saudi Arabia Elbagir Nasser
  • - bmcri , India sanjeev choudri
  • - Hopital de Pau , France Mathieu Cannella
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - Hospital M de Deus , Brazil Thiago Bento da Silva
  • - mann scan/delta scann , India max in
  • - University of British Columbia , Canada Amr Ajlan
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
  • - Okayama university , Japan Takeharu Yamamoto
  • - CH de la Ce Basque , France Paul ARDILOUZE
  • - Doctors Hospital , Bahamas muneesh sharma
  • - Private surgery , New Caledonia Marie Benichou
  • - CHU de Bordeaux , France Franis Laurent
  • - Zaid Alsheriti hospital- Alsweida , Syria jehad alakabani
  • - KUMC ansan , Korea (South) kihwan kim
  • - Vikram hospital , India Pravin Mahadevappa
  • - Istanbul , Turkey Armagan Sarac
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - Saint Malo , France jean-baptiste Noel
  • - CHU Notre-Dame Montreal , Canada Fabrice Bing
  • - Onomichi municipal hospital , Japan Junya Itakura
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - Inha University Hospital , Korea (South) Sung Hee Park
  • - Sahyadri Speciality Hospital, Pune , India Kunal Nadgouda
  • - Shree Diagnostics , India amol jagdale
  • - Chonnam national university hospital , Korea (South) seo yeon Park
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