Massive Hemoptysis in Pulmonary Tuberculosis From Rasmussen Pseudoaneurysm

Abstract

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.

Bronchoscopic view of post-tuberculosis lung cavity: A case report

“…2 Hemoptysis is a common complaint in a patient with a lung cavity, which can be due to bleeding into the cavity from adjacent dilated bronchial arteries or ruptured pseudoaneurysms. 4 Thus, it is important to assess every suspected cavitary TB patient with hemoptysis with contrast-enhanced CT of the thorax and flexible bronchoscopy (as was done in this patient) for early detection and timely intervention of possible pulmonary or bronchial artery aneurysms. 5 The healing response following cavitary TB is incomplete and results in fibrotic scarring which can lead to open or closed healing.…”