Ben Ghorbel I, Ibn Elhadj Z, Khanfir M, Braham A, Fekih M, Drissa H, Houman M H
Service de médecine interne, Hôpital La Rabta, 1007 Tunis, Tunisie.
J Mal Vasc. 2004 Jul;29(3):159-61. doi: 10.1016/s0398-0499(04)96738-8.
Intracardiac thrombus formation is exceptional in Behçet's disease (less than 50 cases had been reported). Among 180 patients with Behçet's disease (according to the criteria of the international study group for Behçet's disease), three were diagnosed as having intracardiac thrombus. All were male, the mean age at the time of the diagnosis of the intracardiac thrombus was 27 years and the mean disease duration was 4.8 years. The presenting symptom was hemoptysis in two patients and heart failure in the third. Surgery was the first attempted treatment in two patients but thrombus recurred and resolved after medical treatment. The third patient was given corticosteroids and anticoagulants as the first line treatment. The thrombus did not resolve and the patient declined surgery. Intracardiac thrombus formation should be considered when a young Behçet's disease patient presents with an intracardiac mass. Medical treatment including corticosteroids, immunosuppressive drugs and anticoagulants should be considered as the first line treatment and surgery should be considered when there is no resolution of the thrombus or when it becomes massive and extensive. In certain cases, thrombolytic treatment becomes an interesting alternative to surgery.
心脏内血栓形成在白塞病中极为罕见(报道的病例少于50例)。在180例白塞病患者中(根据国际白塞病研究组的标准),有3例被诊断为心脏内血栓形成。所有患者均为男性,诊断心脏内血栓时的平均年龄为27岁,平均病程为4.8年。两名患者的首发症状为咯血,第三名患者为心力衰竭。两名患者首先尝试了手术治疗,但血栓复发,经药物治疗后消退。第三名患者接受了皮质类固醇和抗凝剂作为一线治疗。血栓未消退,患者拒绝手术。当年轻的白塞病患者出现心脏内肿块时,应考虑心脏内血栓形成。应将包括皮质类固醇、免疫抑制药物和抗凝剂在内的药物治疗作为一线治疗,当血栓未消退或变得巨大且广泛时,应考虑手术治疗。在某些情况下,溶栓治疗成为手术的一个有趣替代方案。