Rasmussen's Aneurysm in Active Pulmonary Tuberculosis: A Case Report

Abstract

Hemoptysis is a common presenting symptom of pulmonary tuberculosis (TB). Rasmussen aneurysm can present with severe hemoptysis, which is usually diagnosed using computed tomography (CT) angiography. A false aneurysmal dilatation of the pulmonary artery is known as a Rasmussen aneurysm. It occurs due to a gradual weakening of the arterial wall adjacent to pulmonary cavitation. Computed tomography angiography of the chest is the standard diagnostic technique for Rasmussen aneurysm. An early angiographic or surgical procedure with vascular embolization is recommended following a definitive diagnosis. We present a 29-year-old woman whom the medical commission referred due to a cavitary lesion on a screening chest X-ray. Hospital admission was preferred for the Mycobacterium tuberculosis infection workup, which revealed radiological evidence of the Rasmussen aneurysm. The patient was eventually treated as a case of active tuberculosis on a radiological basis via the decision of the local infectious disease (ID) team. The most common symptoms reported in patients with tuberculosis infection are hemoptysis, cough, low-grade fever, night sweats, and weight loss. Hemoptysis can rarely originate from the Rasmussen aneurysm of the pulmonary artery. However, hemoptysis is the predominant symptom in chronic cavitary tuberculosis with Rasmussen aneurysm. A CT pulmonary angiogram (CTPA) is considered the imaging modality of choice to confirm the diagnosis of Rasmussen aneurysm. Fatal hemoptysis is one of the consequences of a Rasmussen aneurysm if it is massive and not treated promptly. Confirming the diagnosis with proper follow-up is essential to preventing devastating outcomes.

Keywords: chest computed tomography; massive hemoptysis; pulmonary artery pseudo aneurysm; pulmonary tuberculosis sequelae; rasmussen’s aneurysm.

Figure 1. A chest X-ray showing a cavitary lesion in the left upper lung zone with hazy opacity seen in the left hilar region.

Figure 2. A coronal view of a chest CT scan revealing a hyperdense rounded lesion in the collapsed left upper lung lobe.

Figure 3. A sagittal view of a chest CT scan revealing a hyperdense rounded lesion in the collapsed left upper lung lobe.

Figure 4. An axial view of a chest CT scan revealing a hyperdense rounded lesion in the collapsed left upper lung lobe.