• Behçet's disease

I read with interest the excellent review of Behçet's disease by Erkan et al¹ and wish to comment on the treatment of pulmonary artery aneurysms (PAA) with embolisation. Durieux et al reported the first case in 1981, and a further four successfully treated cases have been reported since 1985.^2–5

As reported by others,^6–8 we have found that surgical treatment of PAA in Behçet's disease is associated with a high rate of mortality so we have started to use embolisation as the first line of treatment for massive haemoptysis in patients with Behçet's disease. Our first patient underwent embolisation of an aneurysm involving the right middle and lower lobe arteries in January 2000, and a second patient with an aneurysm in the right upper lobe was embolised in October 2000. Both are alive with no apparent haemoptysis and serial control scans show no aneurysm formation. We also had a patient with an aneurysm of unknown aetiology involving the entire pulmonary arterial tree starting from the mean pulmonary artery and extending bilaterally towards the lobar branches. Pulmonary angiography did not reveal leakage and embolisation was not attempted as it was impossible to block the huge aneurysm. He died a week later despite high doses of corticosteroid and azathioprine.

In Behçet's disease PAA are usually multiple and have a tendency to recur. Immunosuppressants should be the first line treatment as regression is possible. Life threatening massive haemoptysis necessitates intervention. Surgical treatment mostly consists of major anatomical resection rather than preserving lung tissue. Embolisation can be performed in most cases and any recurrence may be re-embolised. Pulmonary infarction has not been observed so far, although it is a possibility. Thrombosis of the great veins is a well known problem and surgery should be preferred for life threatening haemoptysis if endovascular access is not available.