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previously visited 13 AA FEMALE WITH HEMOPTYSIS OF 1/2 CUP OF BRIGHT RED BLOOD. Random Case
Authored By: Faculty and residents Children's Hospital, Radiologist, Children's Health System, Birmingham, Alabama., USA.
Patient: 13 year old female
History: 13 year old AA female with history of Popiteal artery thrombus and sternotomy for left ventricular thrombectomy persents with 1/2 cup bright red hemoptysis, tachycardia and mild labored breathing.
Images:small[medium]largeas-submittedimages only

Fig. 1: Chest radiology at admission.

Fig. 2: Chest radiology 5 months earlier.

Fig. 3: Axial CTA

Fig. 4: Axial CTA

Fig. 5: Coronal CTA

Fig. 6: Coronal CTA
Images:small[medium]largeas-submittedimages only
Findings: Chest radiology at admission shows a large round right lower lobe opacity with several smaller more peripheral opacites in both bases. Chest radiology 5 months earlier shows marked cardiac enlargement with LV opacity and questionable right lower lobe opacity. Axial and coronal CTA images show multiple bilateral aneurysms with internal thrombus, right atrial thrombus and peripheral small infarcts.
Diagnosis: Behcet's Disease
Discussion:

Differential for lung opacity with hemoptysis includes PTE, pneumonia, vasculitis, AVM, neoplasm and aneurysm.

Behcet's disease an autoimmune disease with spontaneous remissions and relapses. Attacks can last days to weeks and consist of:
* Recurrent oral aphthae ( most common and earliest) and genital ulcers
* Uveitis or retinal vasculitis
* Cutaneous pustular vasculitis and other skin lesions
* Arthritis and synovitis (inflamed joint lining)
* Gastrointestinal lesions
* Vasculitis with venous and arterial thrombosis and aneurysm formation.
* Central Nervous System involvement such as meningoencephalitis

Genetically linked to HLA-B51 (particularly in Israel)and pediatric patients are more likely to have a family history of Behcet disease. US = 5 / 100,000 persons / Mediterranean region 1 / 10,000 persons.

There is a higher incidence of antibodies to herpes simplex virus, hepatitis C virus, and parvovirus B19.

Treatment consist of corticosteroids, colchicine and cyclosporine for inflammatory control and surgical resection of aneurysms with graft placement if feasible.



References:

e-medicine - Behcet Disease - Sungnack Lee, M.D. et al (March 2003)
e-medicine - Behcet Disease - C Egla Rabinovich, M.D. et al (March 2003)

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Additional Details:

Case Number: 1797102Last Updated: 12-07-2005
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Anatomy: Vascular/Lymphatic   Pathology: Vascular
Modality: CT, Conventional RadiographAccess Level: Readable by all users

Case has been viewed 1227 times.

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