Chest Infections |

Rasmussen Aneurysm and Paragonimiasis Presented as Massive Hemoptysis FREE TO VIEW

Gener Idor, MD; Charisma Idor, MD; Cherry Ann Serra, MD
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University of Perpetual Help Dalta Medical Center, Las pinas, Philippines

Chest. 2014;145(3_MeetingAbstracts):112A. doi:10.1378/chest.1834683
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SESSION TITLE: Infectious Disease Case Reports Posters III

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Hemoptysis in the presence of TB, often massive. It is even fatal once its accompanied with Rasmussen’s aneurysm with concomitant parasitic infection such as paragonimiasis .These diseases as co-infection are rarely encountered.

CASE PRESENTATION: A case of 55 y.o. male, farmer admitted due to massive hemoptysis. Fluid replacement, blood transfusion,tranexamic acid and broad spectrum antibiotics were started.work up were done which revealed anemia and eosinophilia, chest xray showed opacities on both apex with minimal bilateral pleural effusion.patient improved. During his hospital course,he complained of persistent cough with minimal yellowish blood tinged sputum. massive hemoptysis reccurs and 4 units of Packed RBC were transfused.Thoracic contrast-enhance 64 slice multidetector computed tomographic angiography was done which revealed a vascular lesion about 33mm in diameter originates from right pulmonary artery with contrast media extravasation consistent with a ruptured rasmussen’s aneurysm.He was referred to a Thoracovascular surgeon and underwent open thoracotomy with lobectomy . Histopathology result showed granuloma with langhan’s type giant cell consistent with TB. pleural fluid and sputum microscopy revealed yellow brown,90um length 45um wide, ovoid thick shell with clearly visible operculum consistent with parogonimus westermani eggs.Confirmed by ELISA method. He was started on anti-Koch’s and praziquantel. He was discharged on 10th hospital day and undergoing pulmonary rehabilitation.

DISCUSSION: Hemoptysis are benign and self-limited. However, it can be a sign of serious tracheopulmonary disease and may cause death due to asphyxiation. Tuberculosis accounts for fewer cases of massive hemoptysis , it remains a frequent etiology in areas with a high prevalence of the disease, such as Africa and China. Rasmussen's aneurysm is a rare phenomenon caused by weakening of the pulmonary artery wall from adjacent cavitary tuberculosis, with a prevalence of 5% While Chronic paragonimiasis resembles Pulmonary tuberculosis. Persons may cough up coffee-colored or blood-tinged sputum, often accompanied by chest pain and/or shortness of breath. The sputum may be peppered consisting of clumps of eggs produced by the adult fluke living in the lung. Ninety percent of the estimated 22 million people infected with paragonimiasis worldwide reside in Southeast and East Asia. Ruptured Rasmussen’s aneurysm is a rare complication of pulmonary Tuberculosis but in the presence of pre-existing parasitic infection such such paragonimus westermani makes it more uncommon.There’s no local or international literature can be found that tuberculosis and Paragonimiasis might be the possible cause of rupture of pulmonary artery in the case of Rasmussen’s aneurysm.

CONCLUSIONS: Conventional CT and multidetector CT angiography are quick and noninvasive ways to locate the site of bleeding, determine the cause of bleeding and sputum microroscopy should be mandatory in patients living in the tropical areas.

Reference #1: Cleveland Clinic Journal of Medicine August 2008 vol. 75 8 601-607

DISCLOSURE: The following authors have nothing to disclose: Gener Idor, Charisma Idor, Cherry ann Serra

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