From Crisis to Cure: Endovascular Management of Rasmussen Pseudoaneurysm Presenting as Life-Threatening Hemoptysis

Abstract

Background:

Rasmussen’s pseudoaneurysm is a rare and potentially lethal pulmonary vascular complication of tuberculosis. It should be considered in the differential diagnosis of massive hemoptysis in patients known or suspected to have pulmonary tuberculosis. CT angiography is the first investigation to confirm the diagnosis and localize the bleeding source. Endovascular interventions remain the mainstay of treatment in Rasmussen’s pseudoaneurysm, with common embolic agents such as glue, coils, and plugs.

Case Presentation:

A 50-year-old female was diagnosed with pulmonary Koch’s 6 years ago. She took antitubercular therapy for 6 months and was asymptomatic for the last 5 and ½ years. She presented with 2 episodes of massive hemoptysis for the previous 2 days. CT angiography in emergency showed cavitary changes in the left upper lobe with focal contrast-filled outpouching measuring 2 cm × 2 cm from the superior segmental branch of the left descending pulmonary artery. The patient was immediately posted for embolization of the pseudoaneurysm. She had another episode of massive hemoptysis on the cath lab table and went into class II hypovolemic shock. Immediate fluid resuscitation was done. Successful embolization of the pseudoaneurysm sac with glue with proximal coil embolization of the pulmonary artery branch was done.

Clinical Impact

This case highlights the efficacy of combined glue and coil embolisation for managing Rasmussen pseudoaneurysm-induced massive hemoptysis, offering a life-saving, minimally invasive alternative to surgery. It emphasises the importance of early diagnosis using cross-sectional imaging and prompt intervention by interventional radiologists. The technique’s dual approach ensures secure embolisation and reduced recurrence risk. Clinicians should consider this approach in similar cases to minimise mortality and morbidity. This case report further underscores the role of multidisciplinary collaboration in achieving optimal patient outcomes in life-threatening hemoptysis.