Coeliac artery dissection as a rare manifestation of Behcet’s disease

Abstract

Behcet's disease is a multisystemic vasculitis. Arterial involvement in the form of acute dissection is rare. A 42-year-old Lebanese man with Behcet's disease presented with severe abdominal pain. On exam, blood pressure was 162/104 mm Hg, and he exhibited epigastric tenderness. CT angiogram demonstrated an acute dissection of the coeliac artery trunk, common hepatic artery and proper hepatic arteries, with asymmetric thickening of the proximal left subclavian artery and circumferential thickening of the abdominal infrarenal aorta suggestive of vasculitis. Treatment included intravenous clevidipine, nitroprusside and methylprednisolone, which transitioned to oral metoprolol, amlodipine and prednisone. He responded well. Arterial dissections have been described with Behcet's. We report a coeliac artery aneurysm in association with a flare of Behcet's disease. Arterial wall inflammation combined with the sheering forces of hypertension likely predisposes to arterial dissection.

Current status of spontaneous isolated celiac artery dissection

“…The most common misdiagnoses were pancreatitis, 14,15 gastritis, ureteral stone, 16 lymphadenopathy, enteritis, 17,18 peptic ulcer, 19 and pancreas cancer. 20,21 Several risk factors can lead to SI-CAD, including a history of smoking, a higher abdominal pressure, [22][23][24][25][26][27][28] vasculitis, 29 autoimmune disorders, 30,31 food consumption, [32][33][34] median arcuate ligament compression syndrome, 8,35 fibrous dysplasia, 27 and myxoid degeneration of the tunica media (Table 2).…”