Rasmussen aneurysm presenting with massive hemoptysis in a tuberculosis survivor: Diagnosis with CT pulmonary angiography

Abstract

Pulmonary artery pseudoaneurysm (PAP) is a rare but potentially fatal cause of hemoptysis, most commonly associated with tuberculosis or chronic cavitary lung disease. Prompt recognition through imaging is critical to enable timely intervention and improve survival. We report the case of a 57-year-old male with a history of poorly controlled type 2 diabetes mellitus and hypertension who presented with massive hemoptysis. Computed tomography pulmonary angiography (CTPA) revealed a pseudoaneurysm arising from a segmental branch of the left lower pulmonary artery, located within a residual post-tuberculous cavity containing heterogeneous hyperdense fluid suggestive of recent hemorrhage. Digital subtraction angiography (DSA) confirmed the diagnosis, although images were not archived, and the patient underwent successful endovascular embolization. However, he later developed septic shock, hyperosmolar hyperglycemic state, and ultimately suffered cardiac arrest despite supportive care. This case highlights the importance of early diagnosis of PAP using CTPA in patients presenting with hemoptysis, especially those with a history of pulmonary tuberculosis. Despite appropriate endovascular treatment, systemic complications may lead to poor outcomes. Early recognition, aggressive management, and interdisciplinary care are critical to improve prognosis, particularly in patients with comorbidities.