Abstract：
BACKGROUND: Behcet\'s disease (BD) is a chronic inflammatory disorder with arterial vasculitis. Although, pulmonary artery aneurysm (PAA) is accepted as the prototypic arterial disorder, an increasing presence of pulmonary artery thrombosis (PAT) with or without aneurysms was also reported in recent studies. In this study, we aimed to describe computed tomography pulmonary angiography (CTPA) findings of pulmonary involvement and its correlation with symptoms and acute phase response in BD.
METHODS: In this retrospective study, 153 CTPA of BD patients were assessed by two radiologists. Clinical and laboratory data were collected from the patient files. Pulmonary artery involvement (PAI) was defined as thrombus or aneurysm in CT angiography.
RESULTS: Most of (85.6 %) our patients were male and median age was 33.7 ± 10 years during angiographic assessments. Sixty-two (40.5 %) angiographies presented a thrombus: 14 subsegmental, 29 segmental, 13 lobar and 6 main branches. Among these, 82.3 % (n = 51) had bilateral involvement. Isolated PAT was present in 58 (93.5 %) angiographies with only 4 (2.6 %) angiographies displaying an aneurysm together with a thrombus. Pulmonary infarction was detected in 9 angiographies. Forty-four (29.3 %) patients, almost all of them under immunosuppressive treatments for other indications, were screened for asymptomatic pulmonary involvement (without any symptoms or increased acute-phase response (APR)), and one fourth of these were diagnosed as having a segmental or subsegmental PAT.
CONCLUSIONS: Our results show that isolated pulmonary thrombosis is the main form of PAI, and isolated pulmonary aneurysm formation is rare in our BD cases. In the presence of pulmonary symptoms with or without increased APRs, involvement of segmental or more proximal parts of pulmonary arteries is most commonly detected. We also observed that PAI may be seen in about one fourth of especially male BD patients without symptoms or increased APR. Our results suggest that BD patients with pulmonary symptoms should be screened by CTPA for PAI, however, further research is needed to clarify the role of routine CTPA screening in asymptomatic BD patients.
METHODS: In this retrospective study, 153 CTPA of BD patients were assessed by two radiologists. Clinical and laboratory data were collected from the patient files. Pulmonary artery involvement (PAI) was defined as thrombus or aneurysm in CT angiography.
RESULTS: Most of (85.6 %) our patients were male and median age was 33.7 ± 10 years during angiographic assessments. Sixty-two (40.5 %) angiographies presented a thrombus: 14 subsegmental, 29 segmental, 13 lobar and 6 main branches. Among these, 82.3 % (n = 51) had bilateral involvement. Isolated PAT was present in 58 (93.5 %) angiographies with only 4 (2.6 %) angiographies displaying an aneurysm together with a thrombus. Pulmonary infarction was detected in 9 angiographies. Forty-four (29.3 %) patients, almost all of them under immunosuppressive treatments for other indications, were screened for asymptomatic pulmonary involvement (without any symptoms or increased acute-phase response (APR)), and one fourth of these were diagnosed as having a segmental or subsegmental PAT.
CONCLUSIONS: Our results show that isolated pulmonary thrombosis is the main form of PAI, and isolated pulmonary aneurysm formation is rare in our BD cases. In the presence of pulmonary symptoms with or without increased APRs, involvement of segmental or more proximal parts of pulmonary arteries is most commonly detected. We also observed that PAI may be seen in about one fourth of especially male BD patients without symptoms or increased APR. Our results suggest that BD patients with pulmonary symptoms should be screened by CTPA for PAI, however, further research is needed to clarify the role of routine CTPA screening in asymptomatic BD patients.
摘要：
背景：Behcet病（BD）是一种伴有动脉血管炎的慢性炎症性疾病。虽然,肺动脉瘤（PAA）被认为是典型的动脉疾病，最近的研究也报道了有或没有动脉瘤的肺动脉血栓形成(PAT)的增加.在这项研究中,我们旨在描述肺部受累的计算机断层扫描肺动脉造影（CTPA）发现及其与BD症状和急性期反应的相关性。
方法：在这项回顾性研究中，由两名放射科医生评估了153例BD患者的CTPA。从患者档案中收集临床和实验室数据。肺动脉受累（PAI）定义为CT血管造影中的血栓或动脉瘤。
结果：我们的大多数患者（85.6％）为男性，在血管造影评估期间，中位年龄为33.7±10岁。62例（40.5%）血管造影显示血栓：14次节段，29分段，13叶和主枝6。其中,82.3%(n=51)有双侧受累。在58例（93.5％）血管造影中存在孤立的PAT，只有4例（2.6％）血管造影显示动脉瘤和血栓。在9例血管造影中检测到肺梗死。四十四位(29.3%)病人,几乎所有人都接受了其他适应症的免疫抑制治疗，筛查无症状肺部受累（无任何症状或急性期反应（APR）增加），其中四分之一被诊断为有节段或亚节段PAT。
结论：我们的结果表明，孤立性肺血栓形成是PAI的主要形式，在我们的BD病例中，孤立的肺动脉瘤形成很少见。在有或没有APR增加的肺部症状的情况下，肺段或更近端的肺动脉受累最常见。我们还观察到，PAI可能出现在约四分之一的男性BD患者中，没有症状或APR增加。我们的结果表明，有肺部症状的BD患者应该通过CTPA筛查PAI，然而,需要进一步的研究来阐明常规CTPA筛查在无症状BD患者中的作用.
方法：在这项回顾性研究中，由两名放射科医生评估了153例BD患者的CTPA。从患者档案中收集临床和实验室数据。肺动脉受累（PAI）定义为CT血管造影中的血栓或动脉瘤。
结果：我们的大多数患者（85.6％）为男性，在血管造影评估期间，中位年龄为33.7±10岁。62例（40.5%）血管造影显示血栓：14次节段，29分段，13叶和主枝6。其中,82.3%(n=51)有双侧受累。在58例（93.5％）血管造影中存在孤立的PAT，只有4例（2.6％）血管造影显示动脉瘤和血栓。在9例血管造影中检测到肺梗死。四十四位(29.3%)病人,几乎所有人都接受了其他适应症的免疫抑制治疗，筛查无症状肺部受累（无任何症状或急性期反应（APR）增加），其中四分之一被诊断为有节段或亚节段PAT。
结论：我们的结果表明，孤立性肺血栓形成是PAI的主要形式，在我们的BD病例中，孤立的肺动脉瘤形成很少见。在有或没有APR增加的肺部症状的情况下，肺段或更近端的肺动脉受累最常见。我们还观察到，PAI可能出现在约四分之一的男性BD患者中，没有症状或APR增加。我们的结果表明，有肺部症状的BD患者应该通过CTPA筛查PAI，然而,需要进一步的研究来阐明常规CTPA筛查在无症状BD患者中的作用.
