대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 529 Date 2007-12-17

  • Courtesy of Sang Hyun Paik, MD, Jai Soung Park, MD. / Department of Radiology, Soonchunhyang University Bucheon Hospital, Korea.
  • Age/Sex 42 / M
  • Chief ComplaintCough, hemoptysis Phx: intermittent tuberculosis medication for 8 years
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Rasmussen aneurysm with active cavitary pulmonary tuberculosis
Radiologic Findings
Chest PA shows multiple cavities with surrounding nodular opacities in both upper lung zones and decreased volume in LUL with pleural thickening
Pre and post contrast-enhanced CT scan shows multiple cavities with nodular opacities in BLL and round, enhancing, 1.4 x 1.1-cm lesion in superior segment of RLL.
Brief Review
Rasmussen aneurysm is a rare phenomenon caused by weakening of the pulmonary artery wall from adjacent cavitary tuberculosis. .A review of autopsy findings in patients with a history of chronic cavitary tuberculosis showed a 5% prevalence of Rasmussen aneurysm. Hemoptysis is the usual presenting symptom and may be life-threatening when it is massive. Progressive weakening of the arterial wall occurs as granulation tissue replaces both the adventitia and the media. The granulation tissue in the vessel wall is then gradually replaced by fibrin, resulting in thinning of the arterial wall, pseudoaneurysm formation, and subsequent rupture.
Please refer to
Case 193, Case 332,
References
1. 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
Vascular, Lung, Vascular, Bacterial infection, Tuberculosis,

No. of Applicants : 52

▶ Correct Answer : 43/52,  82.7%
  • - VIVUS SMRC Heart centre, Goa, India Paresh Desai
  • - Shinsegye Rad Clinic, Daegu, Korea Gi Beom Kim
  • - Trakya University Edirne, Turkey Armagan Sarac
  • - Registrar in Radiology, UHL NHS Trust, UK A. Donuru
  • - Dept. of radiology, Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
  • - Osaka University, Japan Osamu Honda
  • - UHN & MSH, University of Toronto, Canada Yon Mi Sung
  • - Anandnagar, Hingne Khurd, Pune, India Bankim J. Amin
  • - Asan Medical Center, Korea Eun Jin Chae
  • - India Shiva Rastogi
  • - CHRU Lille hopital calmette, France Toledano Manuel
  • - Pancham MRI and Diagnostic centre, Bareilly, India Praveen Kumar
  • - Dept. of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India Ram Prakash Galwa
  • - Armidale Radiology, Australia Saurabh Khandelwal
  • - Pittwater Radiology, Australia Julie Arora
  • - Vitalife Clinics, Pune, India Rahul Shukla
  • - Dept of Radiodiagnosis, GMCH, Guwahati, India Harikrishnan
  • - Nour El-Islam Radiology Center, Alexandria, Egypt Elsayed Mousa
  • - Hospital Sotiria, Athens, Greece Vasilios Tzilas
  • - Lilavati Hospital & Rsearch Centre, Mumbai, India Mahavir Swami
  • - Mauritius Jeevak Almast
  • - Ajou Univ Hospital, Korea Hyun Woo Noh
  • - Chandigarh, India Sonali Jain
  • - Gimpo Woori Hospital, Korea Son Youl Lee
  • - Yongsan Hospital, College of Medicine, Chung-Ang University, Korea Jae Seung Seo
  • - China Medical University Hospital, Taiwan Jun-Jun Yeh
  • - Soonchunhyang University Cheonan Hospital, Korea Sang Hyun Park
  • - Mokpo Hankook Hospital, Korea Sang Uk Park
  • - Dae-gu Fatima Hospital, Korea Sang Hee Cho
  • - Sree chitra tirunal, India Santhosh Kannath
  • - Homs National Hospital, Homs - Syria Rami Abou Zalaf
  • - Jackson Memorial Hospital, Miami, Florida, USA N.B.S. Mani
  • - Good gang-an hospital, Korea Kyung Hwa Jung
  • - Annemasse, Polyclinique De Savoie, France Gay-Depassier Philippe
  • - Ultra Care Coimbatore, India Debabrata Das
  • - IRSA, La Rochelle, France Denis Chabassiere
  • - Nirman Hitech CT MR centre & Apollo clinic, Mumbai, India Jeshil Shah
  • - CHU Grenoble, France Bing Fabrice
  • - Cape Breton Regional hospital, Sydney, NS, Canada Muhammad Umar Islam
  • - IRSA La Rochelle, France Jean-Luc BIGOT
  • - Aims, New Delhi, India Ashish Gupta
  • - Max Hospital, New Delhi, India Vickrant Malhotra
  • - Ospedale, Santa Maria, Terni, Italy Angelo Carloni
▶ Correct Answer as Differential Diagnosis : 4/52,  7.7%
  • - Annecy hospital, France Gilles Genin
  • - Armed Forces ChunCheon Hospital (AFCC), Korea Chae Hun Lim
  • - Mackay Memorial Hospital, Taipei, Taiwan Chia-Fu Tsai
  • - Hangang Sacred Heart Hospital, Korea Eil Seong Lee
▶ Semi-Correct Answer : 5/52,  9.6%
  • - Shiga University of Medical, Japan Norihisa Nitta
  • - E-Da Hospital, Taiwan Yu-Feng Wei
  • - Pims Loni, Maharashtra, India Sushant Bhadane
  • - Ondokuz Mayis University, Samsun Turkey Cetin Celenk
  • - Vital imaging centre, Mumbai, India Ganesh Agrawal
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