An Uncommon Complication of Behçet's Disease: Intracardiac Thrombosis Needing Surgical Treatment

Kırali, Kaan; Civelek, Ali; Dağlar, Bahadır; Şişmanoğlu, Mesut; Akinci, Esat; Berki, Turan; Işık, Onur; Yakut, Cevat

doi:10.1055/s-2007-1010201

Cited by 30 publications

(14 citation statements)

References 6 publications

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“…As far as intracardiac thrombi are concerned, although surgical removal has the advantage of providing material for histological examination and verification of the diagnosis, thrombolytic therapy has been generally considered as the first choice of treatment because is a faster and readily available treatment [31]. Cardiac thrombi may demand surgical treatment if they cause haemodynamic decompensation or congestive heart failure [31], but recurrence after surgery has been reported [15,21,23,32,33].…”

Section: Discussionmentioning

confidence: 99%

Deep vein and intracardiac thrombosis during the post-partum period in Behçet’s disease

Hiwarkar¹,

Stasi²,

Sutherland³

et al. 2010

Int J Hematol

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A 22-year-old woman presented on the 10th post-partum day with deep vein thrombosis involving the right ilio-femoral and popliteal veins. This thrombosis was refractory to conventional anticoagulation and subsequently over a period of 6 weeks progressed to involve inferior vena cava and right ventricle. A diagnosis of Behçet's disease was made on the clinical grounds of fever, night sweats, and recurrent oral ulcers. In view of refractory thrombosis, anticoagulation with lepirudin was commenced followed by thrombolysis with streptokinase. After thrombolysis, anticoagulation was switched to fondaparinux. Intracardiac thrombus, oral ulcers, constitutional symptoms, and inflammatory indices resolved on 20 mg of oral prednisolone. This case highlights that management of thrombosis unresponsive to conventional anticoagulation requires careful consideration of the underlying conditions, the sites of thrombosis, as well as of the available treatment options. Intravenous lepirudin is a valuable therapeutic option when anticoagulation with warfarin or LMWH is not efficacious. Thrombolytic therapy may be used to treat intracardiac thrombi more rapidly, and possibly more efficiently, than surgery. The addition of corticosteroids or other immunosuppressive drugs is necessary in order to achieve a full resolution of thrombosis.

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Section: Discussionmentioning

confidence: 99%

Deep vein and intracardiac thrombosis during the post-partum period in Behçet’s disease

Hiwarkar¹,

Stasi²,

Sutherland³

et al. 2010

Int J Hematol

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“…Diagnostic and therapeutic cardiac surgical resection has been performed [11, 19, 28, 42–46]. Surgical treatment may be considered in cases unresponsive to optimal medical treatment, ineffective thrombolysis therapy and impaired hemodynamics or if ICT becomes massive and shows recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…There is a risk of recurrence after surgery [5]. After surgical removal of ICT, recurrent thrombus successfully resolves with medical treatment including prednisolon and immunosuppressant [22, 44–46]. Some patients underwent surgery before immunosuppressive therapy [10].…”

Section: Discussionmentioning

confidence: 99%

Behçet’s Disease and Intracardiac Thrombosis: A Report of Three Cases

Düzgün

Küçükşahin

Atasoy

et al. 2013

Case Reports in Rheumatology

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We present three patients with Behçet's disease associated with intracardiac thrombus and pulmonary vascular involvement. One of these patients had also Budd-Chiari syndrome. All patients were treated with corticosteroid plus monthly intravenous cyclophosphamide as first line treatment and with no recurrences. Immunosuppressive therapy was successful in the treatment of intracardiac thrombus and also in the regression of pulmonary vascular thromboses in these patients. Intracardiac thrombus in Behçet's disease is rarely seen. Behçet's disease should be remembered in the differential diagnosis of the patients with intracardiac mass, especially in patients from the Mediterranean and Middle East populations.

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“…Medical management is preferred as a first-line intervention4 6 7 8 with surgical resection reserved in cases of failed medical therapy, recurrent or large cardiac thrombus and where there is diagnostic uncertainty 9…”

Section: Discussionmentioning

confidence: 99%

Rare manifestation of Behcet's syndrome: insight from multimodality cardiovascular imaging

et al. 2012

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SummaryA young Jordanian man was hospitalised with fever of 2 months duration. Preadmission diagnostic assessment including CT thorax and abdomen were inconclusive. Right-sided pleuritic chest pain was present on admission. Pulmonary embolism was suspected on a ventilation/perfusion lung scan. Lower-extremity deep venous thrombosis was, however, absent. Echocardiogram to exclude a cardiac source of pulmonary embolism showed a right ventricle mass which was also present on retrospective review of prehospitalisation CT thorax. Tissue characterisation of this mass on cardiac MRI was not helpful. Empiric anticoagulation was started without reduction in size at 3 weeks. Due to ongoing diagnostic uncertainty, surgical resection was performed. Histopathology confirmed this mass to be a thrombus. With unabated fever, right ventricular thrombosis with pulmonary embolism and cutaneous and scrotal ulceration which evolved later in the hospital course, a diagnosis of Bechet's syndrome was considered and subsequently confirmed. Response to immunosuppressive therapy was prompt. BACKGROUND

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An Uncommon Complication of Behçet's Disease: Intracardiac Thrombosis Needing Surgical Treatment

Cited by 30 publications

References 6 publications

Deep vein and intracardiac thrombosis during the post-partum period in Behçet’s disease

Deep vein and intracardiac thrombosis during the post-partum period in Behçet’s disease

Behçet’s Disease and Intracardiac Thrombosis: A Report of Three Cases

Rare manifestation of Behcet's syndrome: insight from multimodality cardiovascular imaging

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