Abstract
A Rasmussen aneurysm is an uncommon complication of pulmonary tuberculosis (TB) and represents a pulmonary artery aneurysm adjacent or within a tuberculous cavity. Hemoptysis is the usual presenting symptom and may be life-threatening when it is massive. Aim of them study is determining of diagnostic possibilities to prevent hemorrhage.
This is a study of 21.532 patients with confirmed TB. Male patients were 11.987 (55.67%), female 9545 (44.33%). Patients were from 17 to 83 years old. All patients with any sign of hemoptysis were sent to MDCT. MDCT was performed with pulmonary angiography and if it was necessary with perfusion for differentiation of bronchial bleeding. In some cases MRI with diffusion was also performed to determine hemosiderin layers to prevent other late complications.
Rasmussen aneurysms is caused by weakening of the pulmonary artery wall from adjacent cavitary tuberculosis. There is progressive weakening of the arterial wall as granulation tissue replaces both the adventitia and the media. This is then gradually replaced by fibrin, resulting in thinning of the arterial wall, pseudoaneurysm formation, and subsequent rupture with hemorrhage. We found Rasmussen aneurysms in 54 (0.25%) cases. Bronchial aneurysm was found in 78 (0.36%) cases. In 2 cases we found aspergilloma. In 3 cases we found pseudoaneurysm. 21 patient finish lethal.
Massive hemoptysis is a life-threatening condition associated with a mortality rate of 50% and ruptured Rasmussen aneurysms should be considered in patients with massive hemoptysis. Mandatory radiological studies should include thoracic MDCT with angiography to differentiate between bleeding from pulmonary or bronchial origins. MDCT perfusion is very important for diagnosis.
- © 2014 ERS