Rasmussen aneurysm

Rasmussen's aneurysm refers to a rare, but significant, pulmonary aneurysm associated with tuberculosis (TB). It is named after Fritz Valdemar Rasmussen, a Danish physician who first described this condition in the late 19th century. This aneurysm develops as a result of the erosion of a pulmonary artery by a nearby tuberculous cavity, leading to the formation of a pathological connection between the artery and the cavity. This condition is of particular concern due to its potential to cause massive hemoptysis (coughing up of blood), which can be life-threatening.

Etiology and Pathogenesis[edit | edit source]

Rasmussen's aneurysm arises from the chronic inflammatory process of tuberculosis, which affects the lungs and can lead to the formation of cavities. These cavities, in turn, can erode into nearby structures, including blood vessels. When a pulmonary artery is involved, the continuous erosion and weakening of the vessel wall can lead to the formation of an aneurysm. The risk of rupture is significant, given the high-pressure system of the arterial circulation, which can lead to severe bleeding within the lungs.

Clinical Presentation[edit | edit source]

Patients with Rasmussen's aneurysm may present with symptoms of tuberculosis, including chronic cough, weight loss, night sweats, and fever. The hallmark of a Rasmussen's aneurysm, however, is massive hemoptysis, which may be sudden and life-threatening. The diagnosis is often suspected in patients with active or previously treated tuberculosis who present with hemoptysis.

Diagnosis[edit | edit source]

The diagnosis of Rasmussen's aneurysm involves a combination of clinical suspicion and imaging studies. Chest X-rays may show features of tuberculosis but are not specific for the aneurysm. Computed tomography (CT) of the chest, particularly with angiography (CTA), is more effective in identifying the aneurysm and its relation to the tuberculous cavities. Bronchoscopy may be used to identify the source of bleeding within the lungs but may not directly visualize the aneurysm.

Treatment[edit | edit source]

The treatment of Rasmussen's aneurysm focuses on controlling the hemoptysis and addressing the underlying tuberculosis. In cases of life-threatening bleeding, urgent interventions such as bronchial artery embolization (BAE) may be required to control the hemorrhage. This procedure involves the selective occlusion of the artery supplying the aneurysm to prevent further bleeding. Surgical resection may be considered in selected cases, especially when embolization is not feasible or successful. Antituberculous therapy is essential to control the underlying infection and prevent recurrence.

Prognosis[edit | edit source]

The prognosis of Rasmussen's aneurysm depends on the promptness of diagnosis and treatment. With timely intervention, the immediate risk of death from massive hemoptysis can be significantly reduced. However, the overall prognosis is also influenced by the severity of the underlying tuberculosis and the patient's response to antituberculous treatment.