A few weeks ago Leigh presented an interesting case at UMC afternoon delight. A 35 year old Honduran man presented with hemoptysis. We reviewed the “Battle Camp” pneumonic to develop our differential diagnosis.
We discovered that he had previously treated pulmonary tuberculosis. He did not know whether or not he completed treatment. CT chest was negative for pulmonary emboli, but it did show bronchiectasis and findings consistent wtih Rasmusssen’s aneurysm. This is a rare yet potentially life-threatening complication of TB that refers to formation of an aneurysm in the setting of a cavitary lesion that extends into the adventitia and media of bronchial arteries. This causes inflammation and thinning of the vessel walls. If it ruptures, it could cause massive hemoptysis. Luckily for our patient, hemoptysis stopped and hemoglobin remained stable. Coags were normal. he team consulted pulmonology who discussed the patient at their chest conference. He tested covid+ so was unable to have bronchoscopy done while inpatient. There was also concern for bronchitis given some of his other symptoms so he was discharged with antibiotics and pulmonary follow up appointment.
Here are images from a case report showing cavitary lesions and Rasmussen’s aneurysm,
https://www.sciencedirect.com/science/article/pii/S2213007115300241