We have read the case report of Maloberti et al. with great interest [1]. The authors mentioned that aortic mural thrombus in a normal (non-aneurysmal or minimally atherosclerotic) vessel was an uncommon condition. From this point of view, etiologies of an aortic mural thrombus in a non-aneurysmal vessel have been particularly evaluated in their patient. However, no specific etiologic factor has been detected. As a conservative treatment, antiplatelet therapy, low molecular weight heparin and beta-blocker, antihypertensive and lipid-lowering drugs have been initiated. A complete resolution of the thrombus has been observed on control tomography angiography at the 12th day. Related with this case, it would be better to discuss the arterial findings of Behcet's disease, which is highly prevalent among countries around the Mediterranean Sea, e.g. Turkey, Algeria, etc. Behcet's disease is a systemic inflammatory vasculitis of which the etiology is still unidentified and clinical presentation is heterogeneous with multisystemic involvement. Its clinical characteristics are oral and genital ulcers and may be accompanied with reduced bone mineral density, arthritis, cardiovascular, and neurological, gastrointestinal and vascular findings [2]. Prevalence of vascular findings may range between 1 and 38% according to series. Vasculitic lesions can be detected in all vessels ranging from arterioles to great arteries or from venules to great veins. Frequency of venous involvement is higher than arterial involvement. However neutrophilic or monocytic inflammation which may involve the great, middle and small arteries may clinically be more significant. Because vasculitis mediated by cellular infiltration or immune reaction promotes thrombosis by producing endothelial dysfunction. This endovascular and perivascular inflammation may have consequences with thrombosis and aneurysm in arterial system. Involvement of the carotid artery, pulmonary and aorta, iliac, femoral, and popliteal arteries is more frequent [3].
In conclusion, Behcet's disease should be reminded when the etiology of mural thrombus in non-atherosclerotic arteries has been evaluated in cases from countries around the Mediterranean Sea.
Conflict of interest: none declared.
References
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