Kosin Med J.  2017 Jun;32(1):99-104. 10.7180/kmj.2017.32.1.99.

Bronchial Varices in a Patient with Behçet's diasese: A Case Report

• Song JC
• Park BG
• Jeong CH
• Kang HS
• Ahn JH
• Kim JS

• KMID: 2384838
• DOI: http://doi.org/10.7180/kmj.2017.32.1.99

Abstract

We report a case of a 65-year-old man with Behcet's disease who presented with massive hemoptysis caused by bronchial varices. A computed tomography (CT) scan and bronchoscopy were performed to identify the bleeding site. The CT scan revealed pneumonia and a combined hemorrhage in the right-middle and lower lobes. Massive bleeding was detected during the bronchoscopy and emergency embolization was attempted but angiographic findings were normal. An anteriojugulo-right femoral bypass operation was performed to relieve the tortuous and hypertrophied jugular venous obstruction. However, thrombectomy and thrombolysis followed because of graft thrombosis six days post-surgery. The patient was treated with steroid and high-dose cyclophosphamide therapy for his Behçet's disease, which caused the venous obstructions; the saccular bronchial varices in the right-middle and right lower lobes on bronchoscopy regressed slightly after four cycles of cyclophosphamide therapy

Keyword

Behçet's disease; Bronchoscopy; Superior vena cava syndrome

MeSH Terms

Aged
Bronchoscopy
Cyclophosphamide
Emergencies
Hemoptysis
Hemorrhage
Humans
Pneumonia
Superior Vena Cava Syndrome
Thrombectomy
Thrombosis
Tomography, X-Ray Computed
Transplants
Varicose Veins*
Cyclophosphamide

Figure

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  Fig. 1 Visible collateral veins in the abdomen and chest wall.

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  Fig. 2 Contrast-enhanced thoracic computed tomography reveals an obstruction of the superior vena cava (SVC) (A, white arrow) and a narrowed right azygous vein (B, white arrow), resulting in numerous collateral vessels, including bilateral brachiocephalic and subclavian veins with numerous collaterals (C, multiple thin white arrows). Pneumonia in the right-middle and lower lobes and a combined hemorrhage underlying early interstitial fibrosis are visible at the base of both lungs (D, black arrow).

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  Fig. 3 Bronchial varices found on bronchoscopic examination. Bronchial veins are linearly dilated in the right-middle and lower bronchi (white arrows). The bronchial mucosa was edematous and bled easily after being touched by the bronchoscope.

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  Fig. 4 Follow-up bronchoscopy after four cycles of high dose cyclophosphamide showing slightly regressed saccular-form varices in the right-middle and right-lower bronchi, compared with findings from the initial bronchoscopic exam.

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