Ahmet YILDIRIM, Ahmet IŞIK, Nusret SIRMA, Vedat GENCER

Behçet hastalığında subklavian arter psödoanevrizması

Behçet hastalığında aort ve pulmoner arterlerde psödoanevrizma nadir bildirilirken, subklavyan arterlerde daha da az görülmektedir. Yirmi dokuz yaşında erkek hasta, sağ boyun bölgesinde ağrı ve pulsatil kitle nedeniyle başvurdu. Fizik muayenede, sağ klavikula üzerinde hassasiyet, ödem, kızarıklık ve pulsatil kitle vardı. Sol alt ekstremitede eritema nodozum benzeri lezyon (ENBL) skarı ile uyumlu hiperpigmente lezyonlar görüldü. Paterji testi şüpheli pozitifti. Göz muayenesinde geçirilmiş üveit sekeli olduğu saptandı. Kontrastlı toraks tomografisinde subklavyan arterde trombüs içeren psödoanevrizmayla uyumlu görüntü vardı. Olgunun tanısı Behçet hastalığı kabul edildi. Tedavinin dördüncü günü psödoanevrizmanın pariyetal plevraya invaze olarak, intraplevral boşluğa kanaması üzerine şok gelişti. Acil olarak subklavyan arter baypas ameliyatı uygulandı. Yirmi birinci gün greft trombozu gelişti, aynı kateter içinden streptokinaz infüzyonuna başlandı. Tedavi ile 12 saat içinde tam açıklık sağlandı. Üç ay sonra tekrar tromboz gelişmesine karşın kollaterallerin distal doluşu sağladığı görüldü. İdame tedavi ile hastanın klinik takibine devam edilmektedir.

Anahtar Kelimeler:

Behçet sendromu, Anevrizma, yalancı, Erişkin, Erkek, Subklavian arter

Subclavian artery pseudoaneurysm in Behcet's disease

Although pseudoaneurysms in aorta and pulmonary arteries are rarely reported in Behcet's disease, it is even more rare in the subclavian artery. Twenty-nine year-old-male patient presented with pain and a pulsatile mass in the right neck region. Pysical examination revealed hypersensitivity, oedema, rash and a pulsatile mass in the right clavicular area. Hyperpigmented areas compatible with an erythema nodosum like lesion scar were observed in the lower left extremity. Pathergy test was vaguely positive. Sequelae of previous uveitis were evident on ophthalmologic examination. Contrasted thorax tomography revealed an image compatible with a thrombus containing pseudoaneurysm in the subclavian artery. The patient's diagnosis was accepted as Behçet's disease. On the 4th day of therapy, the pseudoaneurysm invaded into the parietal pleura and bleeded into the intrapleural space leading to shock. An emergency subclavian artery bypass operation was performed. Graft thrombosisi occurred on the 21st day, streptokinase infusion was started through the same catheter. Complete patency was achieved in 12 hours by therapy. Although thrombosis occurred after 3 months, it was observed that the collaterals could provide distal filling. The patient's clinical follow-up continues on maintanence doze.

Keywords:

Behcet Syndrome, Aneurysm, False, Adult, Male, Subclavian Artery,

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1) Behçet H. Uber rezidivierende apthose, durch ein virus verursachte Geschwure am Mund, am Auge und an den Genitalien. Dermatol Wochenschr 1937; 105;1152-7.
2) Yurdakul S, Hamuryudan V, Yazici H. Behcet syndrome. Curr Opin Rheumatol 2004;16:38-42.
3) Evaluation of diagnostic (‘classification') criteria in Behcet's disease-towards internationally agreed criteria. The International Study Group for Behcet's disease. Br J Rheumatol 1992;31:299-308.
4) Hamza M. Large artery involvement in Behcet's disease. J Rheumatol 1987;14:554-9.
5) Park JH, Chung JW, Joh JH, Song SY, Shin SJ, Chung KS, et al. Aortic and arterial aneurysms in behcet disease: management with stent-grafts-initial experience. Radiology 2001;220:745-50.
6) Cakir O, Eren N, Ulku R, Nazaroglu H. Bilateral subclavian arterial aneurysm and ruptured abdominal aorta pseudoaneurysm in Behcet's disease. Ann Vasc Surg 2002;16:516-20.
7) Goueffic Y, Pistorius MA, Heymann MF, Chaillou P, Patra P. Association of aneurysmal and occlusive lesions in Behcet's disease. Ann Vasc Surg 2005; 19:276-9.
8) Yanagiya A, Kazui T, Nakanishi K, Yamada O, Sasaki T, Komatsu S. A case of aneurysmal dilatation of a saphenous vein graft for subclavian aneurysm in a patient with Behcet disease. [Article in Japanese] Nippon Geka Gakkai Zasshi 1987;88:903-6.
9) Kalko Y, Basaran M, Aydin U, Kafa U, Basaranoglu G, Yasar T. The surgical treatment of arterial aneurysms in Behcet disease: a report of 16 patients. J Vasc Surg 2005;42:673-7.
10) Tuzun H, Besirli K, Sayin A, Vural FS, Hamuryudan V, Hizli N, et al. Management of aneurysms in Behcet's syndrome: an analysis of 24 patients. Surgery 1997;121:150-6.
11) Durieux P, Bletry O, Huchon G, Wechsler B, Chretien J, Godeau P. Multiple pulmonary arterial aneurysms in Behcet's disease and Hughes-Stovin syndrome. Am J Med 1981;71:736-41.
12) Itoh K, Umehara F, Utatsu Y, Maruyama Y, Osame M. Medullary infarction due to vertebral dissecting aneurysm in a patient with Behcet's disease. [Article in Japanese] Rinsho Shinkeigaku 1996;36:986-9.
13) Wu MH, Lai WW, Lin MY, Chou NS. Massive hemoptysis caused by a ruptured subclavian artery aneurysm. Chest 1993;104:612-3.
14) Corriere MA, Guzman RJ. True and false aneurysms of the femoral artery. Semin Vasc Surg 2005;18:216-23.
15) Kingston M, Ratcliffe JR, Alltree M, Merendino KA. Aneurysm after arterial puncture in Behcet's disease. Br Med J 1979;1:1766-7.
16) Berkmen T. MR angiography of aneurysms in Behcet disease: a report of four cases. J Comput Assist Tomogr 1998;22:202-6.
17) Hama Y, Kaji T, Iwasaki Y, Kawauchi T, Yamamoto M, Kusano S. Endovascular management of multiple arterial aneurysms in Behcet's disease. Br J Radiol 2004;77:615-9.