THE ROLE OF CT PULMONARY ANGIOGRAPHY IN DETECTING RARE VASCULAR ANOMALIES
Keywords:
Behçet’s Disease, pulmonary artery aneurysm, computed tomography pulmonary angiography, Hughes Stovin Syndrome, vascular anomalies, thrombus, migratory aneurysms, vasculitis, diagnostic imagingAbstract
Computed tomography pulmonary angiography (CTPA) is an essential imaging modality in the assessment of pulmonary vascular anomalies, including aneurysms and thrombosis. Pulmonary artery aneurysms (PAAs) are rare but life threatening complications, often associated with vasculitides such as Behçet’s Disease (BD). The sensitivity and specificity of CTPA play a crucial role in the early diagnosis and management of these anomalies.
This study aims to highlight the diagnostic ability of CTPA in detecting PAAs and differentiating them from other rare pulmonary vascular anomalies. Additionally, the study emphasizes the role of CTPA in distinguishing BD
related PAAs from Hughes Stovin Syndrome (HSS), a rare vasculopathy with overlapping features.
A retrospective review of patients diagnosed with PAAs at our institution over five years was conducted. CTPA was used to assess aneurysm size, location, thrombus presence, and disease progression. Sensitivity, specificity, and diagnostic accuracy of CTPA were analyzed using clinical and histopathological correlation.
Among 60 patients evaluated with CTPA for suspected pulmonary vascular anomalies, 12 had PAAs, of which 8 had BD and 2 had HSS. CTPA demonstrated a sensitivity of 92% and specificity of 89% in detecting PAAs. Migratory aneurysms were seen in 75% of BD cases, distinguishing them from HSS.
CTPA is a highly sensitive tool for detecting PAAs and associated thrombotic changes in BD. Its ability to provide high resolution vascular imaging makes it invaluable for distinguishing BD from other vasculopathies such as HSS. Serial CTPA imaging is crucial in monitoring disease progression and guiding treatment to prevent fatal complications.
References
Aikins, A. K., Anderson, N. Z., Bosse, L. B., & Knowles, S. (2024). [Title missing]. Radiology Case Reports, 19(6), 2093–2096. https://doi.org/10.1016/j.radcr.2024.02.054
Aksoy, A., Kocakaya, D., Demircioglu, O., Cimsit, N. C., Yildizeli, B., Karakurt, S., Direskeneli, H., & Alibaz-Oner, F. (2024). Angiographic findings of pulmonary arterial involvement in Behçet's disease: Do they correlate with symptoms and acute phase response? Respiratory Medicine, 221, 107481. https://doi.org/10.1016/j.rmed.2023.107481
Alakkas, Z., Kazi, W., Mattar, M., & Others. (2021). Pulmonary artery thrombosis as the first presentation of Behçet’s syndrome: A case report and review of the literature. Journal of Medical Case Reports, 15, 322. https://doi.org/10.1186/s13256-021-02931-1
Al-Yacopy, A. A., Alhatemi, A. Q. M., Hashim, H. T., Al-Obaidi, A. D., & Abdulhussain, R. (2024). Pulmonaryartery aneurysm in Behçet’s disease manifesting as haemoptysis: A case report and literature review. Oxford Medical Case Reports, 2024(8), omae097. https://doi.org/10.1093/omcr/omae097
Ceylan, N., Bayraktaroglu, S., Erturk, S. M., Savas, R., & Alper, H. (2010). Pulmonary and vascular manifestations of Behçet disease: Imaging findings. American Journal of Roentgenology, 194(2). https://doi.org/10.2214/AJR.09.2763
Dean, R., & Amzuta, I. (2020). Management considerations in a complicated case of Hughes-Stovin syndrome.
Lung Pathology, 158(4), 1579. https://doi.org/10.1016
Giannessi, C., Smorchkova, O., Cozzi, D., Zantonelli, G., Bertelli, E., Moroni, C., Cavigli, E., & Miele, V. (2022). Behçet’s disease: A radiological review of vascular and parenchymal pulmonary involvement. Diagnostics, 12(11), 2868. https://doi.org/10.3390/diagnostics12112868
Kage, H., Goto, Y., Amano, Y., Makita, K., Isago, H., Kobayashi, K., Narumoto, O., Okudaira, R., Tanaka, G.,
Takami, K., Ohishi, N., & Nagase, T. (2016). Development of pulmonary artery aneurysms due to Behçet's disease and resolution after treatment. Internal Medicine, 55(22), 3337–3340. https://doi.org/10.2169/internalmedicine.55.6852
Kandemirli, S. G., & Others. (2016). Giant pulmonary artery aneurysm in Behçet’s syndrome. The Annals of
Thoracic Surgery, 102(4), e363.
Nilay, B. I., Emine, A., Almala, P. E., Cansu, Y. Y., Yasemin, G., Ela, E. E., Ayşim, B. O., & Bulent, K. (2020). An adolescent presented with hemoptysis: Pulmonary artery aneurysm in pediatric Behçet’s disease. Archives of Rheumatology, 35(2), 283–286. https://doi.org/10.46497/ArchRheumatol.2020.7459
Qian, Y.-L., & Others. (2024). Imaging characteristics and prognostic factors of Behçet’s disease with arterial involvement: A long-term follow-up study. European Journal of Radiology, 170, 111206.
Qiu, Y., & Others. (2017). Behçet's disease with pulmonary artery aneurysm and Talaromyces marneffei. International Journal of Infectious Diseases, 54, 34–35.
Samreen, I., Darji, P., Genobaga, S., Doosetty, S., Mohta, T., Maity, G., Vue, C., Nakka, S., & Umeh, C. (2023). Pulmonary artery aneurysm in Behçet disease: Medical, endovascular, or surgical intervention. Cureus, 15(11), 49368. https://doi.org/10.7759/cureus.49368
Yalcin, S., Ensarioglu, K., Kurt, B., & Ozis-Ler, C. (2023). Hughes-Stovin syndrome: A rare cause of thrombosis and pulmonary artery aneurysm. Cureus, 15(4), e37121. https://doi.org/10.7759/cureus.37121
