Rapidly growing aortic arch aneurysm in Behcet's disease

We present a patient with a nine-year history of Behçet's disease (BD), who developed a rapidly expanding aneurysm of the aortic arch. Three-dimensional computed tomography demonstrated a saccular aortic arch aneurysm with a maximal diameter of 5 cm. No bacteria were detected by serial blood cultures. The aneurysm, however, showed a multi-lobular cavity, mimicking an infectious aneurysm. Therefore, we prescribed antibacterial agents for one week. The patient still had a high-fever and an elevated C-reactive protein level thereafter. Aortic arch replacement was performed emergently. Because we were unable to determine whether the aneurysm was caused by infection or BD, the implanted prosthetic graft and the anastomotic sites were covered with a pedicle graft of the greater omentum, and we continued to administer antibacterial agents for four weeks postoperatively. The pathological examination showed neither bacteria nor cystic medial necrosis in the resected aortic wall. Inflammatory changes with eosinophilic infiltration were recognized mainly around the adventitia near the aneurysm. The patient had a favorable postoperative course without any complications.