Hemoptysis Associated With Rasmussen Aneurysm

Abstract

Hemoptysis involves compromised pulmonary vasculature of bronchial versus pulmonary arterial origins, with both life-threatening and non-life-threatening causes. Life-threatening hemoptysis is uncommon. To date, published cases of Rasmussen aneurysm remain low and subsequently underrecognized. We report on a 63-year-old male from Mexico with a more than 30-pack-year smoking history, but no history of lung disease, who presented to the emergency department with cough and hemoptysis for one week. A computed tomography angiography (CTA) chest demonstrated a pseudoaneurysm and hemorrhage, consistent with a Rasmussen aneurysm. Interventional radiology performed a pulmonary angiography, and subsequent coil embolization of the tertiary feeding arteries was performed. This case demonstrates a rare pulmonary artery pseudoaneurysm, known simply as Rasmussen aneurysm, that was successfully managed with coil embolization and highlights the importance of considering the disease in the differential diagnosis for patients with hemoptysis.

Keywords: coil embolization; hemoptysis; pseudoaneurysm; rasmussen aneurysm; tuberculosis.

Figure 1. Chest radiograph from the day of admission demonstrating a right upper lobe cavitary lesion (red arrow).

Figure 2. CTA chest axial view demonstrating an irregular right upper lobe complex cavitary lesion with internal contrast extravasation compatible with a pulmonary artery pseudoaneurysm and hemorrhage, consistent with a Rasmussen aneurysm (red arrow).

Figure 3. CTA chest

A: CTA chest right pulmonary artery oblique maximum intensity projection (MIP) view demonstrating hyperdense focus of contrast extravasation and Rasmussen aneurysm (red arrow). B: Angiography of the segmental pulmonary artery to the right upper lobe demonstrating a Rasmussen aneurysm (red arrow). CTA: computed tomography angiography.

Figure 4. Repeat chest radiograph on hospital admission day 6 shows interval decrease of the right upper lobe cavitary lesion as well as coils from the embolization (red arrow).