J Cardiovasc Ultrasound.  2010 Sep;18(3):108-111. 10.4250/jcu.2010.18.3.108.

Cardiovascular Behcet's Disease Presenting as a Subepicardial Hematoma: An Uneventful 2-Year Clinical Course

• Lee SH
• Chae JK
• Choi JB
• Lee SR
• Rhee KS
• Kim WH
• Ko JK

• KMID: 2177310
• DOI: http://doi.org/10.4250/jcu.2010.18.3.108

Abstract

Cardiovascular involvement in Behcet's disease is not uncommon and could be life-threatening. We describe here a 28-year-old man, who developed sudden onset chest pain during warfarinization due to deep vein thrombosis. Echocardiography and computed tomography showed a 60x60 mm-sized hematoma in the pericardial space compressing the right heart. Coronary angiography showed totally occluded proximal right coronary artery. The hematoma was located at the subepicardial plane of the right atrium on surgical view and successfully evacuated. Follow-up echocardiography revealed complete resolution of the hematoma. He is doing well for 24 months after surgery.

Keyword

Behcet's disease; Hematoma; Coronary artery

MeSH Terms

Adult
Chest Pain
Coronary Angiography
Coronary Vessels
Echocardiography
Follow-Up Studies
Heart
Heart Atria
Hematoma
Humans
Venous Thrombosis
Warfarin
Warfarin

Figure

• 

  Fig. 1 Four-chamber view of multidetector computed tomography on admission. It revealed a 60×60 mm-sized, round mass (H, hematoma) compressing the right atrium and the tricuspid annulus and small amount of hemopericardium (arrows).

• 

  Fig. 2 Transthoracic echocardiography on admission. A: Two-dimensional image showed a 59×55 mm-sized mass (H) adjacent to the right heart extrinsically compressing the tricuspid annulus and small amount of pericardial effusion. B and C: Color Doppler study showed accelerated color flow from the RA to the RV with peak pressure gradient of 16 mmHg. D: IVC was dilated to 27 mm and not collapsed during inspiration. H: hematoma, LV: left ventricle, RV: right ventricle, RA: right atrium, IVC: inferior vena cava.

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  Fig. 3 Coronary angiography. A: Proximal right coronary artery (thick arrow) was totally occluded just below the ostium with some dye staining around the mass (thin black arrows). B: Grade 3 collateral flow from the left coronary artery (thin white arrows) and diffuse enlargement of the proximal segments of the left coronary artery (arrowheads) were found.

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  Fig. 4 Serial two-dimensional echocardiography images. Comparing with preoperative status (A), postoperative echocardiography (B) showed that a substantial volume of hematoma (H, hematoma) still remained. However, the 6th (C) and 12th (D) -month follow-up echocardiography showed complete resolution and no recurrence of the hematoma.

Reference

1. Sismanoglu M, Omeroglu SN, Mansuroglu D, Ardal H, Erentug V, Kaya E, Guler M, Ipek G, Yakut C. Coronary artery disease and coronary artery bypass grafting in Behçet's disease. J Card Surg. 2005. 20:160–163.

2. Sakane T, Takeno M, Suzuki N, Inaba G. Behçet's disease. N Engl J Med. 1999. 341:1284–1291.

3. Atzeni F, Sarzi-Puttini P, Doria A, Boiardi L, Pipitone N, Salvarani C. Behçet's disease and cardiovascular involvement. Lupus. 2005. 14:723–726.

4. Kim KH, Choi JB, Kim KS. Subepicardial hematoma compressing the right atrium: spontaneous rupture of the right coronary artery. Ann Thorac Surg. 2008. 86:e9.

5. Ipek G, Omeroğlu SN, Mansuroğlu D, Kirali K, Uzun K, Sişmanoğlu M. Coronary artery bypass grafting in a 26-year-old man with total occlusion of the left main coronary artery related to Behçet disease. J Thorac Cardiovasc Surg. 2001. 122:1247–1249.

6. Yakut ZI, Odev K. Pulmonary and cardiac involvement in Behçet disease: 3 case reports. Clin Appl Thromb Hemost. 2007. 13:318–322.

7. Al-Mutawa SA, Hegab SM. Behcet's disease. Clin Exp Med. 2004. 4:103–131.

8. Alpagut U, Ugurlucan M, Dayioglu E. Major arterial involvement and review of Behcet's disease. Ann Vasc Surg. 2007. 21:232–239.

9. Ahn JK, Lee YS, Jeon CH, Koh EM, Cha HS. Treatment of venous thrombosis associated with Behcet's disease: immunosuppressive therapy alone versus immunosuppressive therapy plus anticoagulation. Clin Rheumatol. 2008. 27:201–205.

10. Houman MH, Ben Ghorbel I, Khiari Ben Salah I, Lamloum M, Ben Ahmed M, Miled M. Deep vein thrombosis in Behçet's disease. Clin Exp Rheumatol. 2001. 19:S48–S50.

11. Calamia KT, Schirmer M, Melikoglu M. Major vessel involvement in Behçet disease. Curr Opin Rheumatol. 2005. 17:1–8.