Computed tomography pulmonary angiography (CTPA) in Behcet's disease patients: a remarkable gender gap and time to refine the treatment strategy.

OBJECTIVE: The aim of the work was to delineate the computed tomography pulmonary angiography (CTPA) findings in Behcet's disease (BD) patients with and without chest manifestations. PATIENTS AND METHODS: The study included 122 BD adults recruited from 5 Teaching University Hospitals in Egypt of those who agreed to perform a CTPA. The Arabic version of BD current activity form (BDCAF) and BD damage index (BDI) were assessed. Detailed pulmonary manifestations, examination, plain radiology chest, and CTPA findings were recorded. RESULTS: The mean age of patients was 36.9 +/- 11.3 years, male:female was 1.8:1, disease duration 9.6 +/- 8.2 years, and age at onset 28.3 +/- 8.6 years. Their mean BDCAF was 4.4 +/- 2.2 and BDI 3.4 +/- 1.8. There were chest manifestations in 51 (41.8%) and plain chest x-ray findings in 13 (10.7%) and CTPA findings in 31 (25.4%) in the form of pulmonary thromboembolism in 15 (12.3%), pulmonary aneurysms in 7 (5.7%), pneumonia in 5 (4.1%), interstitial lung disease in 4 (3.3%) and pleural effusion in 3 (2.5%). Patients with chest manifestations had significantly higher frequency of cardiac manifestations (15.7%) compared to those without (2.8%; p = 0.023); chest x-ray findings tended to be higher (17.6% vs 5.6%; p = 0.05) while CTPA findings were significantly detected (51% vs 7%; p < 0.0001). Higher frequency of CTPA findings were in females (p < 0.0001). Yet the rate of serious pulmonary embolisms, aneurysms, and thrombosis was exclusive in males. CONCLUSION: Meticulous investigation of the chest manifestations is warranted in BD patients to undermine the actual magnitude of pulmonary impact. CTPA provides a realistic estimate of the extent of involvement even in asymptomatic cases. Key Points * Meticulous chest assessment is warranted in Behcet's disease patients to undermine the actual magnitude of pulmonary impact * CTPA provides a realistic estimate of the extent of involvement even in asymptomatic cases.