Skip to main content

Advertisement

SpringerLink
Log in

Computed tomography pulmonary angiography (CTPA) in Behçet’s disease patients: a remarkable gender gap and time to refine the treatment strategy

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Objective

The aim of the work was to delineate the computed tomography pulmonary angiography (CTPA) findings in Behçet’s disease (BD) patients with and without chest manifestations.

Patients and methods

The study included 122 BD adults recruited from 5 Teaching University Hospitals in Egypt of those who agreed to perform a CTPA. The Arabic version of BD current activity form (BDCAF) and BD damage index (BDI) were assessed. Detailed pulmonary manifestations, examination, plain radiology chest, and CTPA findings were recorded.

Results

The mean age of patients was 36.9 ± 11.3 years, male:female was 1.8:1, disease duration 9.6 ± 8.2 years, and age at onset 28.3 ± 8.6 years. Their mean BDCAF was 4.4 ± 2.2 and BDI 3.4 ± 1.8. There were chest manifestations in 51 (41.8%) and plain chest x-ray findings in 13 (10.7%) and CTPA findings in 31 (25.4%) in the form of pulmonary thromboembolism in 15 (12.3%), pulmonary aneurysms in 7 (5.7%), pneumonia in 5 (4.1%), interstitial lung disease in 4 (3.3%) and pleural effusion in 3 (2.5%). Patients with chest manifestations had significantly higher frequency of cardiac manifestations (15.7%) compared to those without (2.8%; p = 0.023); chest x-ray findings tended to be higher (17.6% vs 5.6%; p = 0.05) while CTPA findings were significantly detected (51% vs 7%; p < 0.0001). Higher frequency of CTPA findings were in females (p < 0.0001). Yet the rate of serious pulmonary embolisms, aneurysms, and thrombosis was exclusive in males.

Conclusion

Meticulous investigation of the chest manifestations is warranted in BD patients to undermine the actual magnitude of pulmonary impact. CTPA provides a realistic estimate of the extent of involvement even in asymptomatic cases.

Key Points

• Meticulous chest assessment is warranted in Behçet’s disease patients to undermine the actual magnitude of pulmonary impact

• CTPA provides a realistic estimate of the extent of involvement even in asymptomatic cases

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Nonaka D, Takase H, Machii M, Ohno K (2020) Colchicine therapy for deep vein thrombosis in a patient with vascular-type Behçet disease: a case report. Medicine (Baltimore) 99(16):e19814

    Article  Google Scholar 

  2. Uzun O, Akpolat T, Erkan L (2005) Pulmonary vasculitis in behcet disease: a cumulative analysis. Chest 127:2243–2253

    Article  Google Scholar 

  3. Ödev K, Tunç R, Varol S, Aydemir H, Yılmaz PD, Korkmaz C (2020) Thoracic complications in Behçet’s disease: imaging findings. Can Respir J 2020:4649081

    Article  Google Scholar 

  4. Badawi AI, Khalil NK, Nabih MI, Saeed M (2015) Two cases of Behçet’s disease with major vessel involvement. Egypt Rheumatol 37(1):41–44

    Article  Google Scholar 

  5. Hassan SZ, Gheith RE, Baz AA, Afifi ZA (2017) Evaluation of asymptomatic venous disease by Doppler ultrasonography in Behçet’s disease patients. Egyptian Rheumatologist 39(3):165–170

    Article  Google Scholar 

  6. Yilmaz S, Cimen KA (2010) Pulmonary artery aneurysms in Behçet’s disease. Rheumatol Int 30(10):1401–1403

    Article  Google Scholar 

  7. Piga M, Puchades F, Mayo I, D’Cruz D (2010) Successful thrombolytic therapy for recurrent right ventricular thrombosis in Behçet’s disease. Clin Exp Rheumatol 28:S76–S78

    PubMed  Google Scholar 

  8. Cinar M, Yilmaz S, Akay S, Bozlar U, Dinc A (2017) Clinical course of Behcet’s disease in a patient with delayed diagnosis and radiological follow-up of the thrombi with computed tomography angiography: a five-year follow-up under immunosuppressive treatment. Rev Bras Reumatol Engl Ed 57(3):264–269

    Article  Google Scholar 

  9. Abarca M, Santamarina M, Vergara C, Vega J (2018) Hemoptysis as the initial manifestation of Behçet’s disease Report of two cases. Rev Med Chil. 146(4):528–33

    Article  Google Scholar 

  10. Tsai HY, Chin CS, Tsai IC (2011) Imaging as a biomarker in Behçet disease: prognostic and therapeutic implications of serial pulmonary CT angiography. AJR Am J Roentgenol 196(1):W105–W106

    Article  Google Scholar 

  11. Hiller N, Lieberman S, Chajek-Shaul T, Bar-Ziv J, Shaham D (2004) Thoracic manifestations of Behçet disease at CT. Radiographics 24(3):801–808

    Article  Google Scholar 

  12. Ceylan N, Bayraktaroglu S, Erturk SM, Savas R, Alper H (2010) Pulmonary and vascular manifestations of Behcet disease: imaging findings. AJR Am J Roentgenol 194(2):W158–W164

    Article  Google Scholar 

  13. Mehdipoor G, Davatchi F, Ghoreishian H, Arjmand Shabestari A (2018) Imaging manifestations of Behcet’s disease: key considerations and major features. Eur J Radiol 98:214–225

    Article  Google Scholar 

  14. Cho YK, Lee W, Choi SI, Jae HJ, Chung JW, Park JH (2008) Cardiovascular Behcet disease: the variable findings of rare complications with CT angiography and conventional angiography and its interventional management. J Comput Assist Tomogr 32(5):679–689

    Article  Google Scholar 

  15. International Criteria for Behçet’s Disease (ICBD), Davatchi F, Assaad-Khalil S et al (2014) The International Criteria for Behçet’s Disease (ICBD): a collaborative study of 27 countries on the sensitivity and specificity of the new criteria. J Eur Acad Dermatol Venereol 28:338–347

    Article  Google Scholar 

  16. Gheita TA, Fathi HM, Eesa NN, El-Shebini E, Tharwat S, Egyptian College of Rheumatology Study Group (2021) Development of an Arabic version of the Behçet’s Disease Current Activity Form (Ar-BDCAF): cross-cultural adaptation and validation initiative in Egypt. Clin Rheumatol 40(11):4609–4618

  17. Gheita TA, Hammam N, Fawzy SM, Abd El-Latif E, El-Gazzar II, Egyptian College of Rheumatology-Behçet’s Disease Study Group (ECR-BDSG) (2021) Development and validation of a Behçet’s Disease Damage Index for adults with BD: an Explicit, Composite and Rated (ECR) tool. Int J Rheum Dis 24(8):1071–1079

    Article  Google Scholar 

  18. Edrees A, Naguib S, El Menyawi M, Ismail I, Nagah H (2017) Pulmonary manifestations in a group of patients with Behcet’s disease. Int J Rheum Dis 20(2):269–275

    Article  Google Scholar 

  19. Wu X, Li G, Huang X, Wang L, Liu W, Zhao Y, Zheng W (2014) Behçet’s disease complicated with thrombosis: a report of 93 Chinese cases. Medicine (Baltimore) 93(28):e263

    Article  Google Scholar 

  20. Fei Y, Li X, Lin S, Song X, Wu Q, Zhu Y et al (2013) Major vascular involvement in Behçet’s disease: a retrospective study of 796 patients. Clin Rheumatol 32(6):845–852

    Article  Google Scholar 

  21. Ahmadzai O, Ozakin E, Canakci ME, Acar N, Korkmaz C (2021) Therapeutic dilemmas regarding anticoagulation, pulmonary embolism, and diffuse alveolar hemorrhage due to Behçet’s disease. Cureus 13(4):e14429

    PubMed  PubMed Central  Google Scholar 

  22. Bennji SM, du Preez L, Griffith-Richards S, Smit DP, Rigby J, Koegelenberg CFN, Irusen EM et al (2017) Recurrent pulmonary aneurysms: Hughes-Stovin syndrome on the spectrum of Behçet disease. Chest 152(5):e99–e103

    Article  Google Scholar 

  23. Hatemi G, Seyahi E, Fresko I, Talarico R, Hamuryudan V (2017) One year in review 2017: Behçet’s syndrome. Clin Exp Rheumatol. 35(Suppl 108(6)):3–15

    PubMed  Google Scholar 

  24. Kızıldağ B, Yurttutan N, Sarıca MA, Atilla N, Baykara M, Şereflican B et al (2018) Insights into chest computed tomography findings in Behcet’s disease. Tuberk Toraks 66(4):325–333

    Article  Google Scholar 

  25. Uzun O, Erkan L, Akpolat I, Findik S, Atici AG, Akpolat T (2008) Pulmonary involvement in Behçet’s disease. Respiration 75(3):310–321

    Article  Google Scholar 

  26. Mogulkoc N, Burgess MI, Bishop PW (2000) Intracardiac thrombus in Behcet’s disease: a systematic review. Chest 118:479–487

    Article  CAS  Google Scholar 

  27. Yazgan Ç, Ertürk H, Taşkın A (2021) Imaging features of thoracic manifestations of Behçet’s disease: beyond pulmonary artery involvement. Curr Med Imaging 17(8):996–1002

    Article  Google Scholar 

  28. Malekmohammad M, Emamifar A (2014) Pulmonary nodules as an initial manifestation of Behçet’s disease. Case Rep Rheumatol 2014:869817

    PubMed  PubMed Central  CAS  Google Scholar 

  29. Kajiya T, Anan R, Kameko MMN, Minagoe S, Hamasaki S et al (2007) Intracardiac thrombus, superior vena cava syndrome, and pulmonary embolism in a patient with Behçet’s disease: a case report and literature review. Heart Vessels 22:278–283

    Article  Google Scholar 

  30. Badr Eldin A, Ibrahim A (2014) Assessment of the relationship between vascular endothelial growth factor and cardiovascular involvement in Egyptian patients with Behçet’s disease. Egyptian Rheumatologist 36(3):131–137

    Article  Google Scholar 

  31. Emad Y, Abdel-Razek N, Gheita T, el-Wakd M, el-Gohary T, Samadoni A (2007) Multislice CT pulmonary findings in Behçet’s disease (report of 16 cases). Clin Rheumatol 26(6):879–884

    Article  CAS  Google Scholar 

  32. Yoshida S, Fujimori K, Hareyama M, Nakata T (2001) Cardiac thrombus in Behçet disease. Chest 120:688–689

    Article  CAS  Google Scholar 

  33. Ouchi K, Narui R, Sakuma T, Ojiri H (2020) Serious complication of anticoagulation in vessel thrombosis-associated Behçet disease. Intern Med 59(13):1615–1620

    Article  Google Scholar 

  34. Isıyel E, Bakkaloğlu S, Oğuz D, Yenicesu İ, Boyunağa Ö, Özdemir Y et al (2019) An adolescent case of extensive Behçet’s disease successfully treated with Infliximab. Turk J Pediatr 61(4):585–588

    Article  Google Scholar 

  35. Geng LN, Conway D, Barnhart S, Nowatzky J (2013) Behcet’s disease with major vascular involvement. BMJ Case Rep 2013:bcr2013200893

    Article  Google Scholar 

  36. Agha A, Bella AM, Assiri AH, Al-Hakami M (2011) Can Behcet’s disease related pulmonary arterial aneurysms be completely resolved? Open Rheumatol J 5:88–90

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia, Egypt

    Samar Tharwat

  2. Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt

    Suzan S. ElAdle & Tamer A. Gheita

  3. Rheumatology Department, Faculty of Medicine, Al-Azhar University, Assuit, Egypt

    Abdel Hafeez Moshrif

  4. Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt

    Faten Ismail & Rawhya El-Shereef

  5. Rheumatology Department, Faculty of Medicine, Assuit University, Assuit, Egypt

    Esraa A. Talaat

  6. Diagnostic Radiology Department, Faculty of Medicine, Assiut University, Assuit, Egypt

    Sara Hassanein

  7. Rheumatology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt

    Yousra Hisham

Authors
  1. Samar Tharwat
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Suzan S. ElAdle
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Abdel Hafeez Moshrif
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Faten Ismail
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rawhya El-Shereef
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Esraa A. Talaat
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sara Hassanein
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yousra Hisham
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tamer A. Gheita
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

on behalf of the Egyptian College of Rheumatology (ECR) Behçet’s disease study groups

Corresponding author

Correspondence to Tamer A. Gheita.

Ethics declarations

Disclosures

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tharwat, S., ElAdle, S.S., Moshrif, A.H. et al. Computed tomography pulmonary angiography (CTPA) in Behçet’s disease patients: a remarkable gender gap and time to refine the treatment strategy. Clin Rheumatol 41, 195–201 (2022). https://doi.org/10.1007/s10067-021-05991-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-021-05991-2

Keywords

Search

Navigation