Background In Behçet’s syndrome (BS) patients with symptomatic pulmonary artery involvement (PAI) varying and multiple pulmonary parenchymal and cardiac lesions can be seen in thorax CT examinations (1). These lesions are pulmonary nodules of ≥ 1 cm (85 %), cavities (47 %), ground-glass opacities (45 %), mild pleural (45 %) and pericardial effusions (21 %), mediastinal lymphadenopathies (21 %) and intracardiac filling defects (28 %).
Objectives Whether these pulmonary and cardiac abnormalities are exclusively observed in symptomatic BS with PAI or in vascular involvement without PAI have not been adequately studied. We now report the frequency of such lesions among BS patients with vascular disease but no PAI along with BS patients with no vascular disease at all.
Methods Consecutive BS patients seen in the outpatient clinic between December 2011 and November 2012 were studied. Those with a disease duration of > 5 years were excluded. Contrasted thorax CT scans were obtained in BS patients with vascular disease along with BS patients with no vascular disease at all. Only patients with no prior history relevant with PAI or those with no pulmonary symptoms such as hemoptysis, cough, chest pain and dyspnea were studied. CT scans were analyzed formally using a checklist by a radiologist who was blinded to the clinical diagnoses of the patients.
Results We studied 49 (43 M/ 6 F) BS patients with vascular involvement and 35 (32 M/3 F) BS patients with no vascular involvement. Lower extremity deep or superficial vein thrombosis was present in all 49 patients with vascular involvement. The mean age (32 ± 7 years vs 33 ± 8 year, respectively) and disease duration (4 ± 3 years vs 3 ± 2 years, respectively) among patients with and without vascular involvement were similar. None of the patients had pulmonary artery aneurysms or thrombosis. Similarly, cavities, pleural or pericardial effusions, and intracardiac filling defects were not observed in any of the scans. The most common parenchymal lesions were nodules of < 1 cm, which were present in 61 % and 37 % patients with and without vascular involvement, respectively, (P = 0.029). Nodules of ≥ 1 cm were only present in 4 patients with vascular disease (8 %) and none of those with no vascular disease. Ground-glass opacities were present in 2 and 3 patients with and without vascular involvement, respectively. The frequency of pulmonary and cardiac lesions in the current study was much less when compared to that found in PAI.
Conclusions Pulmonary parenchymal and cardiac lesions were rarely observed in BS patients with no pulmonary artery involvement. Although small pulmonary nodules (<1 cm) seemed to be more frequent among patients with vascular disease compared to those without, their significance remains to be further studied.
Seyahi E et al. Pulmonary artery involvement and associated lung disease in Behçet disease: a series of 47 patients. Medicine (Baltimore). 2012;91:35-48.
Disclosure of Interest None Declared