Abarca Macarena, Santamarina Mario, Vergara Cristián, Vega Jorge
Unidad de Emergencia de adultos, Hospital Dr. Gustavo Fricke, Viña del Mar, Chile.
Servicio de Radiología, Hospital Naval A. Nef, Viña del Mar, Chile.
Rev Med Chil. 2018 Apr;146(4):528-533. doi: 10.4067/s0034-98872018000400528.
Arterial involvement in Behçet's disease (BD) is less common than venous lesions. The most commonly affected arteries are: the aorta, lower extremity arteries, mesenteric, femoral, coronary, renal, subclavian and pulmonary arteries. The rupture of pulmonary arteries is the main cause of death of patients with EB and the presence of aneurysms is a bad prognostic factor. We report two patients with arterial involvement in BD. A 14 years old male presenting with hemoptysis lasting three days. A chest computed tomography showed an aneurismal dilatation of the right interlobar artery, bilateral intramural thrombi and alveolar hemorrhage. A right lobar pulmonary resection was performed but hemoptysis recurred. Suspecting a BD, prednisone was started and hemoptysis subsided. A 42 years old male presenting with chest pain and hemoptysis. A chest CT scan showed thrombi in pulmonary veins and anticoagulant therapy was started. Two months later he was admitted again due to a massive hemoptysis. The CT scan showed aneurisms in pulmonary arteries, mural thrombi and pulmonary infarction. With the diagnosis of BD, methylprednisolone, followed by prednisone and cyclophosphamide were used, with a good clinical response.
白塞病（BD）中的动脉受累比静脉病变少见。最常受累的动脉有：主动脉、下肢动脉、肠系膜动脉、股动脉、冠状动脉、肾动脉、锁骨下动脉和肺动脉。肺动脉破裂是白塞病患者的主要死亡原因，动脉瘤的存在是不良预后因素。我们报告了两名白塞病动脉受累患者。一名14岁男性，咯血持续三天。胸部计算机断层扫描显示右叶间动脉瘤样扩张、双侧壁内血栓形成和肺泡出血。进行了右叶肺切除术，但咯血复发。怀疑为白塞病，开始使用泼尼松，咯血缓解。一名42岁男性，出现胸痛和咯血。胸部CT扫描显示肺静脉血栓形成，开始抗凝治疗。两个月后，他因大量咯血再次入院。CT扫描显示肺动脉瘤、壁内血栓形成和肺梗死。诊断为白塞病后，使用甲泼尼龙，随后使用泼尼松和环磷酰胺，临床反应良好。
