To the Editor:
We read with interest the review by Mogulkoc and colleagues (August 2000)[1] regarding intracardiac thrombus in 24 patients with Behcet disease previously published in 21 reports. It is also noted that the authors suggest a unique geographic distribution of this condition in the Mediterranean basin and the Middle East. However, several important articles[2-4] from the Far East are not mentioned in the review article, although it is well-known that Japan is one of specific areas to have a high prevalence of Behcet disease. We report herein a case of Behcet disease with cardiac and pulmonary arterial thrombus from a radiologic point of view.
A 19-year-old Japanese man was admitted to our hospital in January 1996 due to hemoptysis and right heart failure. He had undergone the surgical removal of right ventricular thrombus at another hospital 9 months previously. He received a diagnosis of incomplete Behcet disease based on oral ulceration, skin lesion, uveitis, and positive human leukocyte antigen-B51. Enhanced helical CT (Fig 1, top, middle) revealed thrombus of the right atrium, right ventricle, and right pulmonary artery. Indium-ill platelet scintigraphy (Fig 1, bottom) showed strong uptakes in the right-sided heart and right pulmonary hiatus suggesting acute thrombus formations. Scintigraphy clarified the activity of thrombus and contributed to determining the therapeutic strategy against the serious complications of Behcet disease.
[ILLUSTRATION OMITTED]
Helical CT can be helpful in the assessment of thoracic manifestations of Behcet disease including thrombus of the systemic veins, heart, and pulmonary arteries.[2] To our knowledge, there have been no reports of the use of indium-111-labeled platelet scintigraphy in cardiac thrombus in Behcet disease.[1-5] Scintigraphy can be used to determine whether a thrombus is acute or chronic.[6]
The selection of key words for a computerized search of the medical literature using the National Library of Medicine's MEDLINE is important. Our case and several reported cases[2-5] strongly suggest that the Far East should be included among the specific geographic distribution of patients with cardiac thrombus in Behcet disease.
Correspondence to: Satoru Yoshida, MD, Department of Radiology, Muroran City General Hospital, Yamate-chou 3-8-1, Muroran 051-8512, Japan; e-mail: satyoshi@chive.ocn.ne.jp
REFERENCES
[1] Mogulkoc N, Burgess MI, Bishop PW. Intracardiac thrombus in Behcet's disease: a systematic review. Chest 2000; 118: 479-487
[2] Ahn JM, Im JG, Ryoo JW, et al. Thoracic manifestations of Behcet syndrome: radiographic and CT findings in nine patients. Radiology 1995; 194:199 -203
[3] Imai H, Sakakibara M, Yoshida K, et al. Magnetic resonance imaging of cardiovascular thrombi [in Japanese]. J Cardiogr 1985; 15:681-694
[4] Yoshimura H, Ishii J, Watanabe N, et al. A case of cardiovascular Behcet's disease detected as multiple nodular shadows on chest X-ray [in Japanese]. Nihon Kyobu Shikkan Gakkai Zasshi 1997; 35:1074-1079
[5] Yasuo M, Nagano S, Yazaki Y, et al. Pulmonary embolism due to right ventricular thrombus in a case of Behcet's disease. Jpn Circ J 1999; 63:909-911
[6] Kight LC. Scintigraphic methods for detecting vascular thrombus. J Nucl Med 1993; 34:554-561
COPYRIGHT 2001 American College of Chest Physicians
COPYRIGHT 2001 Gale Group
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