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Pulmonary Artery Embolization in Life Threatening Hemoptysis With a Rasmussen Aneurysm FREE TO VIEW

Brendon Colaco, MD; Rajani Jagana, MD; Clinton Colaco, MD; Penchala Mittadodla, MD; Mohan Rudrappa, MD; Nikhil K. Meena, MD
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University of Arkansas for Medical Sciences and the John McClellan Veterans Affairs Medical Center, Little Rock, AR

Chest. 2014;146(4_MeetingAbstracts):139A. doi:10.1378/chest.1992541
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SESSION TITLE: Infectious Disease Cases I

SESSION TYPE: Affiliate Case Report Slide

PRESENTED ON: Sunday, October 26, 2014 at 10:45 AM - 12:00 PM

INTRODUCTION: A Rasmussen aneurysm is an inflammatory pseudo-aneurysmal dilation of a branch of the pulmonary artery adjacent to a tuberculous cavity. It occurs in 5% of patients with such lesions and is rarely reported from western countries which have a low incidence of pulmonary tuberculosis (TB). Life threatening massive hemoptysis from the rupture of a Rasmussen Aneurysm is an uncommon complication of cavitary tuberculosis.

CASE PRESENTATION: A 35 year old woman presented with intermittent low grade fever, progressive dyspnea and recent onset hemoptysis (approximately 20 to 30 ml). Chest X-ray revealed bilateral upper lobe opacities. Bronchoscopy with bronchoalveolar lavage ( BAL) identified blood trickling from the left main-stem bronchus. Computed tomographic angiography was done which showed biapical cavitary lesions with infiltrates and 3 aneurysms. The patient was emergently intubated for worsening hemoptysis and taken to interventional radiology suite where a pulmonary angiogram confirmed 3 left upper lobe aneurysms, 2 of which were actively bleeding. She underwent emergent glue embolization of all three aneurysms. She remained stable post-procedure with no further hemoptysis. Sputum and BAL specimens grew mycobacterium tuberculosis complex and patient was subsequently treated for tuberculosis.

DISCUSSION: Active infection is one of the commonest causes of hemoptysis and anti-microbial therapy usually leads to cessation of the hemoptysis. However, the possibility of Rasmussen’s aneurysm should be considered when hemoptysis occurs in the setting of cavitary lesions and when there is a high clinical suspicion of malignancy or tuberculous infection.

CONCLUSIONS: Prompt recognition of a Rasmussen’s aneurysm can prevent life threatening hemoptysis and also serve to identify patients with mycobacterial disease. The therapeutic options for a Rasmussen’s aneurysm includes correcting coagulopathy if present, treating the infection, bronchial artery embolization and failing these above measures, evaluation for lobectomy/pneumonectomy. Knowledge of this lesion will lead to appropriate diagnostic imaging and subsequent timely intervention can prevent life threatening complications.

Reference #1: Keeling, A. N., Costello, R., & Lee, M. J. (2008). Rasmussen’s aneurysm: a forgotten entity? Cardiovascular and interventional radiology, 31(1), 196-200

Reference #2: Shih, S. Y., Tsai, I. C., Chang, Y. T., Tsan, Y. T., & Hu, S. Y. (2011). Fatal haemoptysis caused by a ruptured Rasmussen's aneurysm. Thorax, 66(6), 553-554

DISCLOSURE: The following authors have nothing to disclose: Brendon Colaco, Rajani Jagana, Clinton Colaco, Penchala Mittadodla, Mohan Rudrappa, Nikhil K. Meena

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