Early detection of thoracic vessels involvement in patients with behcet's disease having one episode of lower extremity deep vein thrombosis

ABSTRACT

To determine the risk of thoracic vessels involvement in patients with Behcet's disease [BD] presenting with lower extremity deep vein thrombosis [DVT]. The study was performed from August 1997 to April 1998, on 10 patients with BD, who had at least one episode of DVT in the lower extremities in their past or present illness. The diagnosis of DVT was based on physical examination and sonography and/or Doppler sonography. Medical history taking regarding pulmonary symptoms such as cough, with or without sputum production, dyspnea, chest pain, and hemoptysis as well as physical examination, including vascular examination, was performed in all the cases. A new chest x-ray was taken from all 10 cases and following an informed consent, 7 patients had a high resolution CT scan [HRCT] of the chest. All of the 10 studied cases underwent thoracic vessels angiography using the intra-venous digital subtraction angiography [IVDSA] method. The analysis of data was done using Fisher's exact test and student T-Test. Out of the 10 studied cases, seven were male and three were female. Three patients had only one episode, while the other 7 had more than one episode of DVT in the lower extremities. The time interval from diagnosis of BD to the emergence of vascular lesions was 7.8 years. Regarding respiratory manifestations, 5 out of 10 cases were symptomatic and the rest were asymptomatic. Chest x-rays of 9 out of 10 cases were normal, while in one case changes in favor of pulmonary artery aneurysm [PAA], were observed. HRCT scans from the thoracic cage were done in 7 out of 10 cases, with 3 positive findings, [2 with pulmonary artery thrombosis [PAT] and 1 with superior vena cava obstruction [SVCO]]. On thoracic vessel IVDSA 6 cases with positive findings were detected [3 with PAA, 3 with SVCO, and 2 with pulmonary artery thrombosis], in both symptomatic and asymptomatic cases. [Fisher exact =0.4850][p value=0.05%, t [9] = 1.97, risk = 30%]. Gender and pulmonary symptomatology had no significant effect with respect to the results. Patients with [BD] with at least one episode of DVT in the lower extremities have a 30% risk of thoracic vessels involvement by non-invasive angiography using the IVDSA method. Hemoptysis is a late heralding sign for thoracic vessels involvement in BD patients with thrombophelebitis of the lower extremities. Therefore, we recommend radiological screening of thoracic vessels by IVDSA method in this group of BD patients, especially in areas with an increased prevalence of BD. Chest x-ray is not a good screening method for detection of thoracic vessels involvement although HRCT scan can be a helpful procedure for detection of thrombosis in thoracic vessels