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.

Keywords: case report; cavitary tuberculosis; haemoptysis; male; rasmussen’s aneurysm; transarterial embolization; tuberculosis.

Figure 1. Chest x-ray posteroanterior view shows multiple cavitary lesions in bilateral upper zones and right mid-zone. Air-spaced opacities scattered throughout the bilateral (Right > Left) lung parenchyma. Tractional bronchiectatic changes in the right upper and lower lung zones. Red arrow indicates cavity at bilateral upper zone whereas white arrow indicates tractional bronchiectasis in right lower lung zone.

Figure 2. Plain CT axial section reveals multiple cavitary lesions throughout lung parenchyma.

Figure 3. On the post-contrast study, the arterial phase axial section shows a well-defined dilated vascular channel arising from the branch of the right pulmonary artery within a large cavity in the right middle lobe with homogenous intense enhancement similar to the aorta in the arterial phase image.