Altay, Servet

Gürdoğan, Muhammet

Yılmaztepe, Mustafa Adem

Balkan Medical Journal

English

Trakya University Academic Open Access System

Balkan Med J 2020;37:112Clinical Image 112A	Spider	in	the	Spider’s	View:	Behçet’s	Disease-related	Giant	Coronary	AneurysmDepartment of Cardiology, Trakya University School of Medicine, Edirne, TurkeyServet	Altay,	Muhammet	Gürdoğan,	Mustafa	Adem	YılmaztepeA	47-year-old	man	with	a	history	of	Behçet’s	disease	was	admitted	to the cardiology clinic with exertional dyspnea of three months’ duration. His physical examination revealed a blood pressure and heart rate of 120/70 mmHg and 81 bpm, respectively, with normal heart and pulmonary auscultation. Blood biochemical parameters, including troponin I and D-dimer tests, were in the normal ranges. Serial electrocardiography (ECG) findings were normal. The exercise ECG test, which was performed for typical chest pain, showed a 1.5 mm ST-segment depression in leads V4-V6. His coronary angiography revealed a large coronary aneurysm at the left anterior descending (LAD) and diagonal artery (DA) border. On the left anterior oblique caudal view (or spider view), his left coronary system resembled a spider (Figure 1). Coronary artery by-pass surgery was performed on two vessels with the LAD-left internal mammary artery and DA-saphenous graft for treating the severe aneurysm and vascular findings. There were no adverse events at the long-term follow-up of the patient. Written informed consent was obtained from the patient for publication.Behçet’s	disease	is	an	autoinflammatory	disease	that	is	characterized	by recurrent oral and urogenital ulcers (1). Genetic and environmental factors	 may	 participate	 in	 the	 pathogenesis	 of	 Behçet’s	 disease	(2). Although arterial manifestations are uncommon, patients may present with femoral and pulmonary arterial aneurysm, aortitis, and arterial thrombosis. Coronary artery aneurysm remains a very rare pathology	 in	Behçet’s	disease,	 reported	 in	approximately	0.5%	of	patients (3,4). Its etiology involves inflammatory endarteritis of the vasa vasorum. This inflammation leads to the destruction of the tunica media and fibrosis, with resulting arterial wall weakening and	aneurysm	formation	(4).	Patients	with	Behçet’s	disease	should	be followed up in the cardiology clinic, and the management of cardiac risk factors is necessary. Physicians should be aware of the complications of this disease.Conflict of Interest: No conflict of interest was declared by the authors.REFERENCES1.	 Bulur	I,	Onder	M.	Behçet	disease:	New	aspects.	Clin	Dermatol	2017;35:421-34.2.	 Tezcan	ME.	No	Family	Clustering	in	Behçet’s	Syndrome.	Balkan	Med	J	2019;36:145-6.3. Ozeren M, Mavioglu I, Dogan OV, Yucel E Reoperation results of arterial involvement in	Behçet's	disease.	Eur	J	Vasc	Endovasc	Surg	2000;20:512-6.4. Rajakulasingam R1, Omran M, Costopoulos C. Giant aneurysm of the left anterior descending	artery	in	Behçet's	disease.	Int	J	Rheum	Dis	2013;16:768-70.	Address for Correspondence: Servet Altay, Department of Cardiology, Trakya University School of Medicine, Edirne, Turkey e-mail: svtaltay@gmail.com ORCID: orcid.org/0000-0001-7112-3970Received: 02 December 2019 Accepted: 09 December 2019 • DOI: 10.4274/balkanmedj.galenos.2020.2019.12.7Available at www.balkanmedicaljournal.orgCite this article as:Altay	S,	Gürdoğan	M,	Yılmaztepe	MA.	A	Spider	in	the	Spider’s	View:	Behçet’s	Disease-related	Giant	Coronary	Aneurysm.	Balkan	Med	J	2020;37:112©Copyright 2020 by Trakya University Faculty of Medicine / The Balkan Medical Journal published by Galenos Publishing House.FIG. 1. Coronary angiography reveals a large coronary aneurysm at the left anterior descending and diagonal artery border (arrow). On the left, the anterior oblique caudal view (or spider view), the left coronary system resembles a spider.DA: diagonal artery, LAD: left anterior descending

A Spider in the Spider’s View: Behçet’s Disease-related Giant Coronary Aneurysm

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A Spider in the Spider’s View: Behçet’s Disease-related Giant Coronary Aneurysm

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