Rare and Lethal Bleeding Cause of Pulmonary Tuberculosis

Abstract

Background: Pulmonary aneurysms and pseudoaneurysms are caused by a variety of factors; however, Rasmussen's pseudoaneurysm refers to a focal dilation of a pulmonary artery branch into the adjacent tuberculous cavity. The incidence of such tuberculosis related pulmonary vascular complication is extremely rare, hence, under recognized by many physicians. Pulmonary pseudoaneurysms are challenging to treat because they cause life-threatening hemoptysis. Furthermore, unlike the majority of causes of massive hemoptysis, their bleeding originates in the pulmonary rather than bronchial arteries. Since this is associated with an extremely high death rate, prompt diagnosis and early therapies are required. Case description: We present a case of a young male who presented to our hospital with recurrent episodes of massive hemoptysis and was diagnosed with pulmonary tuberculosis. His hemoptysis persisted despite active treatment. In this case, we discuss the role of various diagnostic modalities as well as the available therapeutic options. Conclusion: Rasmussen's pseudoaneurysm is a rare and potentially fatal tuberculosis pulmonary vascular complication. It should be considered in the differential diagnosis of hemoptysis in patients known or suspected to have pulmonary tuberculosis. Prior to therapeutic interventions, multidetector computed tomography (MDCT) scanning is the investigation of choice to confirm the diagnosis and localise the source of bleeding. There is no head-to-head comparison of interventional radiology procedures and surgery in the treatment of pulmonary pseudoaneurysm, so the choice is dependent on availability and local expertise.