Massive Hemoptysis Due To Rasmussen’s Aneurysm – Successful Treatment with Pulmonary Artery Coiling
Journal Title: International Journal of Medical Science And Advanced Clinical Research (IJMACR) - Year 2019, Vol 2, Issue 2
Abstract
Rasmussen's aneurysm is an inflammatory pseudo-aneurysmal dilatation of a branch of pulmonary arterywithin or adjacent to a tuberculous cavity. Although uncommon, hemoptysis from the rupture of a Rasmussen's aneurysm can be massive and life threatening and is a dreaded complication of cavitary tuberculosis (TB). We describe the case of a young gentleman who presentedwith low-grade fever and massive bouts of hemoptysis due to cavitating tuberculosis which did not respond to conservative measures and anti-tuberculosis drugs. Computed tomographic (CT) angiographyrevealedaneurysmal dilatation of the right lower lobe pulmonary artery branch adjacent to the cavity wall, which was successfully treated with catheter guided trans-pulmonary arterial glue embolization. Key words: Massive hemoptysis, Rasmussen’s aneurysm, Pulmonary artery pseudo aneurysm, pulmonary artery coiling, endovascular coilingIntroduction Massive hemoptysis is a medical emergency which might necessitate coordinated multidisciplinary care from pulmonologists, intensivists, interventional radiologists, anaesthesiologists and thoracic surgeons. Airway management is crucially important and is the first step followed by prompt diagnostic tests to establish the aetiology. With life threatening bleeding not responding to conservative measures, interventional procedures help to arrest on-going bleed, provide time for definitive therapy and avoid further cardio-respiratory compromise. Tuberculosis still continues to pose significant medical threat in the developing world. Hemoptysis can occur in both active and quiescent TB. The causes of hemoptysis in TB are manifold. Minor hemoptysis in active TB is often self-limited and settles with a few days to weeks of anti-tubercular therapy along with conservative measures. However, life threatening hemoptysis is often arterial in origin which warrants urgent intervention. Rasmussen's aneurysm is an inflammatory pseudo-aneurysmal dilatation of a branch of a pulmonary artery (PA). We hereby present the case of a young gentle man who presented with massive hemoptysis from a disrupted Rasmussen’s aneurysm needing lifesaving intervention and airway management.
Authors and Affiliations
Jolsana Augustine D. N. B.
Keywords
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