An 18-year-old male patient presented with a 3-month history of chest pain in the left hemithorax, with pleuritic features, associated with episodes of hemoptysis.
Personal and family history was negative.
A review by systems reported that two years ago she presented intermittent appearance of painful ulcerated lesions in the oral and scrotal mucosa that lasted approximately 2 weeks and resolved spontaneously for those who had not sought medical care.
She was initially admitted to a local hospital in her region, where initial studies with chest X-rays and sputum smears were performed and reported as normal.
Due to the persistence of the symptoms, 3 weeks later he consulted again with the described picture of cough and hemoptysis.
A new imaging study was carried out at the local hospital, with a chest X-ray showing a left paracardiac radio-opaque image, which was sent to the Central Military Hospital for further studies.
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On physical examination at admission, the patient presented vital signs: HR 98 BP 115/70 presented with RR 1°C, significant mucocutaneous mucoidity, and wet oral mucosa.
Cardiopulmonary level: tachycardia, normal heart sounds without murmurs, decreased breath sounds on the basis of left hemithorax.
Attention was paid to the presence of lesions described in the review by systems, with 2 ulcers of 0.5 cm in the oral mucosa of the lower lip and an ulcer of 1 cm in diameter at the level of the scrotum of the right testicle.
The rest of the physical examination was within normal limits.
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In the initial studies a blood count with heterogeneous microcytic anemia (Hb 6.3 MCV 76 RDW 18) was found, with no alteration in other cell lines.
Additionally, blood gases and plasma electrolytes were within normal limits.
It was decided to study the image found in the chest X-ray with a computerized axial tomography, which showed a left paracardiac mass with well-defined borders with density of blandom tissues that measured approximately 8x10x6.
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With the suspicion of vascular injury it was decided to carry out pulmonary arteriography which showed an aneurysm of the left pulmonary artery that extended to the artery to the lower lobe.
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At that moment, the lesion was embolized and subsequently underwent surgery, finding an aneurysm of the left pulmonary artery branch to the lower lobe, with thrombus inside, performing lobectomy of the lower pulmonary lobe.
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Due to the involvement of mucous membranes (oral ulcers and scrotum), with the presence of the described aneurysmal lesion, Behçet's disease was considered as a diagnostic possibility, so the patergia test was performed.
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She was diagnosed with cleft lip and palate with posterior pupillary synechiae (green patches) and pigment in the anterior capsule of the crystalline lens (beetle).
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The immunological profile of the patient shows negative ANAS andANCAS with HLA typing positive for A24, A26, B27 and B35.
Treatment consisted of steroids (prednisone 1 mg/kg/day) and azathioprine.
The clinical evolution was favorable, so it was decided to continue ambulatory management by the rheumatology, thoracic surgery and radiology services.
