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Weekly Chest CasesCases by Disease Category

Case No : 1256 Date 2021-11-16

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  • Courtesy of Min Cheol Kim / Seoul National University Hospital
  • Age/Sex 24 / M
  • Chief ComplaintC.C.> hemoptysis PHx> intermittent fever, cough, night sweat since 2 months ago
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Rasmussen aneurysm with active pulmonary tuberculosis
Radiologic Findings
Fig 1. Chest PA shows multiple nodular opacities in both lungs and cavities in the right upper lung zone.
Fig 2-4. Contrast-enhanced CT scans show multiple centrilobular nodules with a tree-in-bud appearance in both lungs with upper lobe predominance. Multiple cavities are seen in the RUL. There is a 1 cm-sized round, enhancing lesion within a cavitary nodule in the RUL.
Fig 5. Digital subtraction angiography reveals a pseudoaneurysm arising from a segmental branch of the right upper lobe pulmonary artery.
Brief Review
Rasmussen aneurysm is a rare vascular complication in patients with pulmonary tuberculosis and has only been seen in 4% of chronic TB patients on autopsy. It is defined as an inflammatory pseudo-aneurysmal dilatation of a pulmonary artery caused by erosion into the artery by an adjacent tuberculous cavity. Progressive weakening of the arterial wall arises when granulation tissue takes the place of both the adventitia and the media. This granulation tissue is then gradually replaced by fibrin, causing thinning of the arterial wall, constitution of pseudoaneurysm, and consecutive rupture. Hemoptysis is the usual presenting symptom and may be life-threatening when it is massive.
Attentive evaluation of unenhanced and post-contrast CT scan of lungs will show a focal enhancing lesion from a pulmonary artery, adjacent to tuberculous parenchyma or chronic tuberculous cavity. These aneurysms arise from segmental pulmonary arteries. CT angiography or Digital Subtraction Angiography (DSA) can confirm the diagnosis. Urgent endovascular transcatheter embolization is considered ideal for managing hemoptysis.
Please refer to
Case 529, Case 332, Case 193,
References
1. Chatterjee K, Colaco B, Colaco C, Hellman M, Meena N. Rasmussen's aneurysm: A forgotten scourge. Respir Med Case Rep. 2015;16:74-76.
2. Corr P. Pulmonary artery aneurysm as a cause of massive hemoptysis: diagnosis and management. Case Rep Radiol. 2011;2011:141563.
3. Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH. Thoracic sequelae and complications of tuberculosis. Radiographics 2001;21(4):839-58.
Keywords

No. of Applicants : 113

▶ Correct Answer : 90/113,  79.6%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Korea University Guro Hospital , Korea (South) SEOKYOUNG LEE
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Niigata University , Japan ATSUSHI UEHARA
  • - Ajou University Hospital , Korea (South) SUNG HYUN AN
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
  • - Other , Korea (South) HYEJIN YANG
  • - , Korea (South) HYEYOUNG CHOI
  • - Other , Korea (South) MINGI SHIN
  • - CH de la Cote Basque , France PAUL ARDILOUZE
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - CHCB , France LE GUEN RAPHAEL
  • - Osaka Red Cross Hospital , Japan YUSUKE UTSUNOMIYA
  • - NIMS, HYDERABAD , India BHASKAR K
  • - Inje University Haeundae Paik Hospital , Korea (South) HYUNGIN PARK
  • - Az Osp Santa Maria Terni , Italy ANGELO CARLONI
  • - , Italy PAOLO BALDASSARI
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Chungbuk National University Hospital , Korea (South) JIYUN KANG
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Korea University Ansan Hospital , Korea (South) BYUK GYUNG CHOI
  • - Ajou University Hospital , Korea (South) KYUNGMIN LEE
  • - Seoul National Hospital , Korea (South) JIN-YOUNG AHN
  • - Other , Korea (South) SEONGSU KANG
  • - , Turkey MEHMET DURAN
  • - Inje University Pusan Paik Hospital , Korea (South) DA SOM KIM
  • - , Korea (South) JIN YOUNG LEE
  • - , China FANG YING GEN
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - The first affiliated Hospital of Xiamen University , China Qing Qiang Guo
  • - Korea University Ansan Hospital , Korea (South) HYO YOUNG KIM
  • - Osaka University , Japan AKINORI HATA
  • - Ajou University Hospital , Korea (South) HAEIN LEE
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
  • - , Korea (South) SUNHYANG LEE
  • - Other , Korea (South) HYEON IL CHOI
  • - , Korea (South) HYEWON CHOI
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Ajou University Hospital , Korea (South) MINJI KIM
  • - Seoul National University Bundang Hospital , Korea (South) SUNG HYUN YOON
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
  • - Kyeongpook National University Hospital , Korea (South) HYEONJUN JANG
  • - Yeungnam University Medical Center , Korea (South) JONGSOO PARK
  • - Gifu University Hospital , Japan Yo Kaneko
  • - McGill , Canada MUTAZ ADNAN KHAIRO
  • - Asan Medical Center , Korea (South) SUNGWON KIM
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - , Korea (South) YOU NA KIM
  • - , Korea (South) EUNJIN LEE
  • - Mallinckrodt Institute of Radiology , United States NAGANATHAN MANI
  • - radiology institut , France MARIE MICHOUD
  • - Osaka City General Hospital , Japan SHU MATSUSHITA
  • - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Centre Hospitalier Regional de Lanaudiere , Canada MATTHIEU STORME
  • - AIMS , India NITHYA HARIDAS MALIYAM
  • - Korea University Guro Hospital , Korea (South) HYEJIN PARK
  • - Scansworld , India PHILSON JOSEPH MUKKADA
  • - Seoul Veterans Hospital , Korea (South) SEONG WON JANG
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Chungbuk National University Hospital , Korea (South) PARK JUN HYEON
  • - Columbia asia hospital Hebbal ,Bengaluru , India PRAVIN KUMAR M
  • - Osmania Medical College, Hyderabad , India PURUSHOTHAMA RAO TUMMALA
  • - TB centre kasaragod. , India rikhy krishnan
  • - , Korea (South) HAJUNG KIM
  • - Other , Korea (South) KYU-CHONG LEE
  • - Tashkent Medical Academy , Uzbekistan Rustam Azimovich Fayzullaev
  • - Kyoto University Hospital , Japan SATOSHI IKEDA
  • - Samsung Medical Center , Korea (South) SUHO KIM
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Chonbuk National University Hospital , Korea (South) DONG HAN SHIN
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - , Japan KAZUMA TERAUCHI
  • - Chonnam National University Hospital , Korea (South) SEUNG WAN KANG
  • - Private sector , Greece VASILIOS TZILAS
  • - Rasoul Akram generel hospital of Iran university of medical science , Iran MOHAMAD REZA AYOUBPOUR
  • - College of Medicine, CHA University , Korea (South) PARK JONG WON
  • - Govt. Kilpauk Medical College, Chennai , India VIGNESH K
  • - , Japan YUKI HAYASHI
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - , Korea (South) WONJU HONG
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Hanyang University Hospital , Korea (South) SEUNG JIN YOO
  • - algeria , Algeria ZAKARIA CHERAGA
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 2/113,  1.8%
  • - dayanand , India REENA GUPTA
  • - Other , Korea (South) MINSU KIM
▶ Semi-Correct Answer : 17/113,  15.0%
  • - , Japan HIROAKI ARAKAWA
  • - , Japan JUN KANZAWA
  • - Affilitated Hospital of Jining Medical college , China JIANG SHENG HUA
  • - , United Kingdom SAMSON KADE
  • - National Center of Neurology and Psychiatry , Japan MOTO NAKAYA
  • - Asan Medical Center , Korea (South) EUNJI CHOI
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - HHS , Canada S LEE
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - , Taiwan SHIHHAN PAN
  • - Chonbuk National University Hospital , Korea (South) MINJEE KIM
  • - , Russian Federation PUSSI KILLER
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - The First Affiliated Hospital of NJMU , China LIJUN TANG
  • - , Japan YUMI MAEHARA
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