Behçet's disease: abdominal vasculitis

Case contributed by Dr Mostafa Mahmoud El Feky

Presentation

Known Behçet disease. Vomiting, fever, abdominal pain past one day.

Patient Data

Age: 40 years
Gender: Male
CT

CT abdomen with contrast

Small and large intestinal loops are dilated with diffuse mural thickening. Bowel loops are fluid-filled with high densities suggestive of sloughed mucosa/hemorrhagic contents.

Mesenteric vascular congestion with a varicose appearance of the mesenteric veins and beaded appearance of the mesenteric arteries. Multiple small filling defects are noted along the mesenteric vessels suggestive of partial thrombotic changes.

Wedge-shaped cortical hypodensity with non-enhancement post-contrast involving the lateral upper and middle zones of the left kidney (left renal infarction).

Partial filling defect is noted at the bifurcation of the left branch of the portal vein extending to its subsegmental branches (left portal vein thrombosis).

Focal thrombus noted at the IVC at the level of the right renal vein.

Mild free ascites.

Case Discussion

The patient has a known history of Behçet disease and presented with persistent abdominal pain. There was diffuse ischemic changes to the bowel as well as multiple abdominal vascular thrombotic changes involving mesenteric vessels, left portal vein, inferior vena cava and left kidney infarction. These changes suggest a common aetiology of vasculitis considering the patient's history of Behçet disease. Gastrointestinal manifestations of Behçet disease mimic Crohn's disease. However, acute involvement of mesenteric vessels results in acute bowel ischaemia.

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Case information

rID: 55955
Published: 9th Oct 2017
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included
Institution: DAR ELASHAA center

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