Rasmussen's pseudoaneurysm- case report

Pseudoaneurysm as an Etiological Cause of Hemoptysis in Extensive Tuberculosis

Hemoptysis is a life-threatening emergency and a possible first sign of pulmonary tuberculosis. Minor hemoptysis, as a possible clinical aspect of adult tuberculosis, usually has limited course and in most cases, is resolved with antitubercular therapy. However, massive hemoptysis is a life-threatening condition associated with a mortality rate of >50% in the absence of well-timed and proper handling. Hence, prompt diagnosis and early interventions are essential. In this study, we present a rare case of pseudoaneurysm causing massive hemoptysis in a patient with pulmonary tuberculosis.

Massive Hemoptysis in Pulmonary Tuberculosis From Rasmussen Pseudoaneurysm

Massive hemoptysis due to pulmonary tuberculosis is a life-threatening complication; it occurs as a result of the erosion of one of the pulmonary vessels. Tuberculous vascular lesions can also lead to arteritis, thrombosis, arterial dilation and Rasmussen aneurysms. "Rasmussen aneurysm" is a rare cause of hemoptysis. The extent of hemoptysis varies in severity from mild to life threatening, which is more common. Here, we report a case of a 45-year-old Indian male who initially presented with cough, and generalized weakness; his clinical, laboratory, and radiological findings were highly suggestive of pulmonary tuberculosis. Following medical ward admission, two weeks later he had worsening of his respiratory status complicated by massive hemoptysis and dropped oxygen saturation requiring intubation and admission to the intensive care unit. His computed tomography angiography revealed localized aneurysmal dilatation of the pulmonary artery in the left lower lobe (Rasmussen aneurysm); embolization was performed successfully. Due to the poor respiratory reservoir in most pulmonary TB cases, interventional radiology is preferred over surgery.

Rasmussen's Aneurysm: A Rare Case

Rasmussen’s aneurysm is a very uncommon condition occurring in post-pulmonary tuberculosis patients. We are presenting a case of a young male patient with the chief complaints of hemoptysis, breathlessness on exertion, cough with expectoration and fever, and weight loss. A thorough radiological examination revealed multiple cavitary lesions, bronchiectasis, tree-in-bud appearance and pulmonary nodules, and areas of air-spaced opacities, indicating a likely diagnosis of post-primary pulmonary tuberculosis with stages of active infection and healed infection. The post-contrast study revealed a well-defined dilated vascular channel arising from a branch of the right pulmonary artery indicating pseudo-aneurysm formation, i.e., Rasmussen’s aneurysm, within a large cavity in the right middle lobe. The patient underwent emergency trans-arterial embolization successfully and he was stable postoperatively. 

Life-threatening hemoptysis accompanied by internal thoracic artery aneurysms in a 28-year-old perinatal woman: a case report

Background

Life-threatening hemoptysis presents an immediate diagnostic and therapeutic challenge, especially during the perinatal period.

Case presentation

A 28-year-old perinatal woman with no significant past medical or surgical history presented with repeating hemoptysis and respiratory failure. Computed tomography revealed a 2.1 × 3.2  cm² inhomogeneous tumorous lesion in the right superior mediastinum and a right main bronchus obstruction along with atelectasis of the right lung. Bronchoscopy showed a tumorous protrusion blocking the right main bronchus with active hemorrhage, and malignancy was suspected. Bronchial artery embolization (BAE) was performed to control the bleeding. The arteriogram revealed tortuosity, dilation and hypertrophy of the right bronchial arteries and aneurysms of the internal thoracic artery (ITA). The bleeding completely stopped after BAE. Bronchoscopy was performed again to remove residual blood clots. The patient recovered soon after the procedure and was discharged.

Conclusions

Life-threatening hemoptysis concomitant with ITA aneurysms, which may have a misleading clinical diagnosis and treatment options, has not been reported previously in perinatal women. BAE could be used as a first-line treatment irrespective of the underlying causes.