Rasmussen's Aneurysm: A Rare Case

Abstract

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.

Successful Endovascular Management of Recurrent Hemoptysis due to Multiple Rasmussen Aneurysms in a Case of Pulmonary Tuberculosis: A Rare Case Scenario

“…This initial compromise is ultimately compounded by the further supplantation of the granulation tissue with the markedly less robust fibrin. The culmination of this pathological odyssey is a demonstrably thinned and structurally compromised arterial wall, rendering it exceedingly susceptible to the formation of a pseudoaneurysm [5,6,11,[14][15][16][17][18].…”

“…Granulation tissue replaces the structurally supportive adventitia and media layers, ultimately being replaced by less robust fibrin. This progressive deterioration renders the wall thin and susceptible to pseudoaneurysm formation [11,[14][15][16][17][18].…”

Hemoptysis Associated With Rasmussen Aneurysm

“…A pseudoaneurysm, not contained by all three layers of the vascular wall, is unstable and can easily bleed into the lung parenchyma or bronchial tree [ 7 ]. A Rasmussen aneurysm is an inflammatory pseudoaneurysmal dilatation of a pulmonary artery branch arising in segmental pulmonary arteries secondary to the gradual weakening of the adjacent pulmonary arterial wall [ 4 , 12 , 13 ]. CT pulmonary angiography is the imaging modality of choice to confirm this disease in patients with hemoptysis [ 14 ].…”

“…CT pulmonary angiography is the imaging modality of choice to confirm this disease in patients with hemoptysis [ 14 ]. Endovascular occlusion using gel foam, arterial coiling, or stent grafts are the treatment modalities of choice, with urgent angiographic endovascular embolization being preferred due to its low invasiveness [ 13 , 14 ]. Surgical resection of the affected pulmonary lobe is reserved for refractory bleeding [ 3 ].…”

“…Additionally, various pulmonary vascular abnormalities can lead to hemoptysis, and understanding potential underlying mechanisms as well as their features on imaging is required for accurate identification and interpretation. Bronchial-pulmonary and arteriovenous (AV) communications are disposed to rupture through pseudoaneurysm formation [ 13 ]. On CT, AV malformations are typically identified by recognizing the enlarged, tortuous feeding artery and enlarged draining vein [ 5 ].…”