Rasmussen's Aneurysm - A fatal and rare complication in post COVID-19 pneumonia

ABSTRACT

Background: Post COVID -19 infection has wide range of presentation, cavitation and fungal infections were very common in these patients especially when they are immune compromised. This is a case study of a post covid patient with cavitary consolidation and Rasmussen's aneurysm secondary to invasive aspergillus infection. Case Study A 62 year old gentleman, hypertensive, diabetic and survivor of severe COVID-19 infection presented with low grade fever, breathlessness and cough with expectoration. The CT scan showed bilateral cavitary consolidation . Sputum examination showed aspergillus growth and MTB negative. Serum galactomannan was positive. While getting treated with antifungal therapy for invasive aspergillus infection, he had one episode of massive haemoptysis. CT angiography showed Rasmussen aneurysm and planned for bronchial artery embolization. But the patient was not willing for any urgent intervention and got discharged on request after stabilisation, warning signs were explained. After 5 days patient had massive haemoptysis followed by circulatory collapse. Patient could not be saved even after resuscitation measures and emergency intubation. Discussion: Rasmussen's aneurysm is a pseudo-aneurysmal dilatation of a branch of pulmonary artery secondary to chronic inflammation in a contiguous cavity. The reported incidence of such pathology is around 5% in cavitary lesions. It may ruptures into the cavity, producing massive haemoptysis. Conclusion: Rasmussen aneurysm itself is a very dangerous entity irrespective of its etiology. Early interventions to prevent the fatal haemoptysis is the management strategy as conservative treatment may not give us enough time to act at the time of emergency.