Massive hemoptysis following Rasmussen's aneurysm: a case report

Rasmussen's aneurysm (RA) is a pseudoaneurysm of a pulmonary artery (AP), adjacent to or within a tuberculous cavity, appearing in 5% of these lesions. Its rupture might provoke massive hemoptysis (MH) with a near 50% mortality. The aim of this article is to report a case of massive hemoptysis following Rasmussen's aneurysm. 52-year-old man with recent history of hospita-lization due to pneumonia associated to influenza A and decompensated hyperthyroidism, pre-sents outpatient chest radiograph with signs of hyperinflation and scarring apical opacities, the patient returned to the hospital due to sharp pain of left hemi thorax during inspiration accom-panied with bloody sputum, asthenia and non-quantified weight loss. He evolves to frank MH, requiring endotracheal intubation managed in the intensive care unit (ICU). Chest computed tomography (CT) reported ground-glass opacity, nodules with a tendency to cavitation, tree-in-bud pattern in agreement with inflammation and infection, active TB is considered, and truncus of PA with vascular lesion suggestive of aneurysm dependent on pulmonary circulation, possibly RA. Fibrobronchoscopy reported signs of old and recent bleeding of left bronchial tree, probably of the lingula, blood clots in right bronchial tree. Molecular study and TB cultures was negative. Endovascular procedure with arteriography was carried out, revealing amputation of left distal segmental PA carrying the pseudoaneurysm with complete regression, discarding embolization RA It must be considered among the differential diagnoses of MH, especially on patients with pulmonary TB complications, such as the reported case. Due to its associated increased morta-lity, once RA is identified, it must be either endovascularly or surgically eradicated.

A case of massive hemoptysis due to Rasmussen aneurysm and successful embolization with micro-coil / 대한내과학회지

No abstract available.

A Case of Endobronchial Mass-Like Rasmussen Aneurysm / 결핵

A 69 year-old female was admitted to the hospital due to intermittent hemoptysis for 1 month. Emergent bronchoscopy revealed mass-like lesion almost completely obstructing right intermediate bronchus with multiple hemorrhagic spots. Bronchial arterial angiography was performed but failed to find out actively bleeding vessel. Spiral computerized tomography of the chest showed contrast enhanced bulging of the posterior portion of right main bronchus into the lumen of right intermediate bronchus suggesting Rasmussen aneurysm. The AFB smear of bronchial washing fluid was positive. Pulmonary arterial angiography and embolization were not performed due to improvement of clinical course with medical conservative care. Here we report a case of endobronchial mass-like Rasmussen aneurysm grossly suspected by bronchoscopy and diagnosed by spiral CT, which successfully managed by medical conservative care with antituberculous agents.

A Case of Rasmussen Aneurysm Treated by Pulmonary Arterial Embolization / 결핵

A 42 year-old male with a history of multidrug-resistant pulmonary tuberculosis suddenly developed massive hemoptysis. Embolization of a bronchial artery branch and the collateral systemic arteries did not resolve the recurrent bleeding. Spiral computerized tomography(spiral CT) of the chest showed contrast enhanced nodules within a large cavity at the left lower lobe in the arterial phase suggesting a Rasmussen aneurysm. A pulmonary angiogram showed abnormal vascular nodules at that site. Coils were deployed at both the proximal and distal vessels of this aneurysmal sac for embolization. Transcatheter arterial embolization is a safe and effective means of controlling bleeding from this pulmonary arterial pseudoaneurysm. Here we report a case of a Rasmussen aneurysm diagnosed by spiral CT, which was successfully treated by pulmonary arterial embolization with a coil.