A 43-year gentleman with recurrent hemoptysis, recurrent genital and oral ulcers since 5 years.

A 43-year gentleman with recurrent hemoptysis, recurrent genital and oral ulcers since 5 years.

A 43-year gentleman with recurrent hemoptysis, and recurrent genital and oral ulcers for 5 years.

  • Fig 1 & 2. Axial and Sagittal contrast CT Pulmonary angiogram images demonstrate a large saccular aneurysm arising from the superior segmental artery of right lower lobar pulmonary artery with diffuse wall thickening – probable eccentric thrombus. There is compression of distal lower lobe segmental pulmonary arteries by the aneurysm (arrow).
  • Fig 3. Axial CT image Lung window: Perifocal ground glass opacity along the saccular aneurysm in the right lower lobe. 
  • Fig 4. VR image of pulmonary artery aneurysm.

Post coiling of pulmonary artery aneurysm.

DIAGNOSIS:

Right pulmonary artery aneurysm with partial eccentric thrombus.

DISCUSSION:

Behçet disease is a multisystemic and chronic relapsing inflammatory disorder characterized by the histopathologic finding of nonspecific vasculitis involving various sized vessels in multiple organs.

Key imaging manifestations are:

  1. Pulmonary thromboembolism.
  2. Pulmonary artery aneurysm.
  3. Sinus of Valsalva aneurysm.
  4. SVC syndrome.
  5. Intracardiac thrombosis.
  6. Mediastinal fibrosis.
  7. Intestinal ulceration (and inflammatory changes).
  8. Budd-Chiari syndrome.
  9. Cerebral venous thrombosis.
  • Identification of a vascular lesion is important because it seriously affects a patient’s prognosis. The leading cause of sudden death in patients with Behçet disease is rupture of a large aortic or arterial aneurysm
  • To improve the detection of these various radiologic findings, examinations should be well-selected and optimized in patients with Behçet disease. 

REFERENCES:

  1. Mehdipoor G, Davatchi F, Ghoreishian H, Shabestari AA. Imaging manifestations of Behcet’s disease: key considerations and major features. European journal of radiology. 2018 Jan 1;98:214-25.
  2. Chae EJ, Do KH, Seo JB, Park SH, Kang JW, Jang YM, Lee JS, Song JW, Song KS, Lee JH, Kim AY. Radiologic and clinical findings of Behçet disease: comprehensive review of multisystemic involvement. Radiographics. 2008 Sep;28(5):e31.

Dr. Deepali Saxena,
DNB, Fellowship Cardiothoracic Imaging (USA)
Lead Cardiothoracic Imaging
Manipal Hospitals Radiology Group.
Unit coordinator, Whitefield

Dr. Vivek Jirankali,
MD
Senior resident and cross-sectional fellow
Manipal Hospitals Radiology Group.