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Thoracic Manifestations of Behçet Disease at CT¹

¹ From the Department of Radiology, Hadassah University Hospital, Ein-Kerem, Jerusalem, Israel 91120 (N.H., S.L., J.B.Z., D.S.); and the Department of Internal Medicine, Hadassah Mount Scopus University Hospital, Jerusalem, Israel (T.C.S.). Presented as an education exhibit at the 2002 RSNA scientific assembly. Received April 1, 2003; revision requested May 16 and received June 27; accepted June 27. All authors have no financial relationships to disclose. Address correspondence to D.S. (e-mail: dshaham@hadassah.org.il).

View larger version (160K): [in a new window]   Figure 1.  Pulmonary artery aneurysms with mural thrombi in a 13-year-old girl who presented with hemoptysis. Semicoronal contrast material-enhanced chest CT scan (mediastinal window) shows extensive bilateral pulmonary artery aneurysms and mural thrombi (arrows).

View larger version (118K): [in a new window]   Figure 2.  Pulmonary artery aneurysm in a 37-year-old patient with hemoptysis. Axial contrast-enhanced chest CT scan (mediastinal window) demonstrates an aneurysm of the right main pulmonary artery (arrows). Note the apparent wall thickening due to vasculitis or thrombosis.

View larger version (111K): [in a new window]   Figure 3a.  Pulmonary artery aneurysms in a 20-year-old patient with hemoptysis. (a) Contrast-enhanced chest CT scan (mediastinal window) shows vasculitis and thrombosis in multiple peripheral pulmonary arteries. Note the large aneurysm on the left side and the smaller ones on the right side (arrows). (b) Contrast-enhanced chest CT scan (lung window) again shows the aneurysms (thin arrows). Note also the small, peripheral round lesion in the lingula (thick arrow), a finding that is probably due to vasculitis or infarction. (c) CT scan obtained 2 years later following therapy shows complete resolution of the pulmonary artery aneurysms.

View larger version (99K): [in a new window]   Figure 3b.  Pulmonary artery aneurysms in a 20-year-old patient with hemoptysis. (a) Contrast-enhanced chest CT scan (mediastinal window) shows vasculitis and thrombosis in multiple peripheral pulmonary arteries. Note the large aneurysm on the left side and the smaller ones on the right side (arrows). (b) Contrast-enhanced chest CT scan (lung window) again shows the aneurysms (thin arrows). Note also the small, peripheral round lesion in the lingula (thick arrow), a finding that is probably due to vasculitis or infarction. (c) CT scan obtained 2 years later following therapy shows complete resolution of the pulmonary artery aneurysms.

View larger version (127K): [in a new window]   Figure 3c.  Pulmonary artery aneurysms in a 20-year-old patient with hemoptysis. (a) Contrast-enhanced chest CT scan (mediastinal window) shows vasculitis and thrombosis in multiple peripheral pulmonary arteries. Note the large aneurysm on the left side and the smaller ones on the right side (arrows). (b) Contrast-enhanced chest CT scan (lung window) again shows the aneurysms (thin arrows). Note also the small, peripheral round lesion in the lingula (thick arrow), a finding that is probably due to vasculitis or infarction. (c) CT scan obtained 2 years later following therapy shows complete resolution of the pulmonary artery aneurysms.

View larger version (94K): [in a new window]   Figure 4.  Aortic wall thickening. Axial contrast-enhanced chest CT scan (mediastinal window) demonstrates marked thickening of the descending aortic wall due to aortitis (arrow).

View larger version (84K): [in a new window]   Figure 5.  SVC wall thickening in a 40-year-old patient who presented with SVC obstruction. Contrast-enhanced chest CT scan (mediastinal window) demonstrates marked thickening of the SVC wall due to vasculitis (arrows).

View larger version (133K): [in a new window]   Figure 6.  SVC thrombosis in a 62-year-old patient with a 25-year history of SVC occlusion. Contrast-enhanced chest CT scan (mediastinal window) demonstrates a narrow and fibrotic SVC (thick arrow) and extensive collateral vessels in the mediastinum and chest wall (thin arrows).

View larger version (133K): [in a new window]   Figure 7a.  Vasculitis with hemorrhage and infarction. (a, b) Chest CT scans (lung window) obtained at different levels of the right lower lobe demonstrate focal areas of high attenuation in the periphery of the lobe (arrows), findings that represent vasculitis with hemorrhage and infarction. (c) Chest CT scan (lung window) obtained in a different patient demonstrates similar findings in the right upper lobe (arrows).

View larger version (128K): [in a new window]   Figure 7b.  Vasculitis with hemorrhage and infarction. (a, b) Chest CT scans (lung window) obtained at different levels of the right lower lobe demonstrate focal areas of high attenuation in the periphery of the lobe (arrows), findings that represent vasculitis with hemorrhage and infarction. (c) Chest CT scan (lung window) obtained in a different patient demonstrates similar findings in the right upper lobe (arrows).

View larger version (92K): [in a new window]   Figure 7c.  Vasculitis with hemorrhage and infarction. (a, b) Chest CT scans (lung window) obtained at different levels of the right lower lobe demonstrate focal areas of high attenuation in the periphery of the lobe (arrows), findings that represent vasculitis with hemorrhage and infarction. (c) Chest CT scan (lung window) obtained in a different patient demonstrates similar findings in the right upper lobe (arrows).

View larger version (112K): [in a new window]   Figure 8.  Pulmonary hemorrhage in a 28-year-old patient with massive hemoptysis. Chest CT scan (lung window) shows patchy consolidation in the left lower lobe (arrow), a finding that is consistent with pulmonary hemorrhage.

View larger version (124K): [in a new window]   Figure 9.  Infectious pneumonia. Chest CT scan (lung window) demonstrates pneumonia in the right upper lobe (arrows).

View larger version (86K): [in a new window]   Figure 10.  Vasculitis of the pleura. Chest CT scan (lung window) demonstrates bilateral areas of hypoattenuation in the upper lobes due to either hypoperfusion or air trapping. Note also the peripheral focal lesion in the left upper lobe (black arrow) and multiple tiny pleural nodules in both lobes (white arrows), the latter findings being consistent with vasculitis of the pleura.

View larger version (117K): [in a new window]   Figure 11.  Small airway disease. Chest CT scan (lung window) shows small airway disease with a "tree-in-bud" appearance and mild bronchiectatic changes (thin arrow) in the right lower lobe. Note also the linear scarring (thick arrow).

View larger version (124K): [in a new window]   Figure 12.  Pleural effusion. Contrast-enhanced chest CT scan (mediastinal window) demonstrates a small right pleural effusion (arrows).

View larger version (110K): [in a new window]   Figure 13.  Inflammatory mediastinal mass in a 36-year-old patient. Contrast-enhanced chest CT scan (mediastinal window) demonstrates a diffuse mediastinal process surrounding the mediastinal vessels (arrows). Analysis of the needle biopsy specimen revealed benign lymphocytic infiltration.

View larger version (126K): [in a new window]   Figure 14.  Pericardial effusion. Contrast-enhanced chest CT scan (mediastinal window) demonstrates moderate pericardial effusion.

View larger version (92K): [in a new window]   Figure 15.  Coronary artery aneurysm in a 20-year-old patient. Contrast-enhanced chest CT scan (mediastinal window) shows a calcified aneurysm of the left anterior descending coronary artery (arrow).