Rasmussen’s Aneurysm: A Forgotten Entity?

Abstract

We present the case of a rare entity which is a complication of a disease process that had almost disappeared from the Western World. With the recent resurgence in reported cases of Mycobacterium tuberculosis (TB) in Western communities, it is important to recognize complications and sequelae. A young alcoholic male with confirmed active TB suffered a cardiac arrest following massive haemoptysis. Multidetector computed tomography angiography diagnosed a Rasmussen's aneurysm, confirmed by digital subtraction angiography and then successfully embolized with glue. We outline this rare case and the embolization technique and review previously documented reports.

Massive Hemoptysis: An Update on the Role of Bronchoscopy in Diagnosis and Management

“…Peripheral PA pseudoaneurysms may also develop in such conditions and become a source of massive bleeding [35]. Other causes of massive PA hemorrhage have included bronchovascular fistulization in the context of lung transplant-related airway anastomotic ischemic or infectious necrosis [36,37,38], Rasmussen’s aneurysms [39,40], and diagnostic or therapeutic procedure-related bleeding (e.g. transbronchial lung biopsy [41], endobronchial brachytherapy [42] and lung radiofrequency ablation [43]).…”

Tuberculous abdominal aortic pseudoaneurysm with renal and vertebral tuberculosis: a case and literature review

“…In 1959, Prophetis [5] reported a successful resection of such pseudoaneurysm in the thoracic aorta. But tuberculous pseudoaneurysms may occur anywhere along the arterial system via different infectious pathways of the arterial wall [6,7,10,12,16,17,19,25,27]. Different positions of tuberculous pseudoaneurysm have distinct names; tuberculous pulmonary pseudoaneurysm is called Rasmussen aneurysm [25], and aortic pseudoaneurysm is called Pott's disease [28].…”

“…At present, surgery of choices include open surgery (in situ reconstruction [8][9][10][11] or extra-anatomic bypass [7,16]) and interventional therapy (embolization [14,17,21,25], stenting [26], or endovascular aneurysm repair [13,23,24,[28][29][30]) along with anti-tuberculosis therapy. The most common operation is resection of the infected arterial segment, debridement of the surrounding tissues, and revascularization of the lower extremities using grafts brought through uninfected tissues remote from the infected site (extra-anatomic bypass).…”

“…But tuberculous pseudoaneurysms may occur anywhere along the arterial system via different infectious pathways of the arterial wall [6,7,10,12,16,17,19,25,27]. Different positions of tuberculous pseudoaneurysm have distinct names; tuberculous pulmonary pseudoaneurysm is called Rasmussen aneurysm [25], and aortic pseudoaneurysm is called Pott's disease [28]. It is therefore of great importance to know the different approaches through which tubercle bacilli reach the arterial wall: (i) the bacilli may implant directly on the internal surface of the vessel wall; (ii) the bacilli may be carried to the adventitia or media by the vasa vasorum; (iii) infection may reach the vessel wall by the lymphatics of the vasa vasorum; or (iv) the outside of the vessel wall may be affected by direct extension from a neighboring tuberculous lymph node, abscess, or bone.…”

Rasmussen’s Anuerysm Mimicking as a Fungal Ball

“…Surgical resection of the involved site allows the definitive recovery when the patient is operable, however it carries a 20% mortality. 1,10 Embolisation, however is a emergency and temporary intervention. Surgical resection can be performed in surgically fit patient and when expertise for radiological intervention is not available as in our case.…”