Life-Threatening Hemoptysis Secondary to Rasmussen’s Aneurysm in an HIV Patient. Hemoptisis amenazante secundaria a aneurisma de Rasmussen en. Rasmussen aneurysm (not to be confused with Rasmussen encephalitis) is an uncommon complication of pulmonary tuberculosis and represents a pulmonary . [en] The authors report a case of an year-old boy with a Rasmussen Aneurisma de Rasmussen – relato de um caso em crianca e revisao da literatura.
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Sem tratamento, os pseudoaneurismas podem aumentar ou sofrer ruptura. Pulmonary artery pseudoaneurysms may be caused by infection, trauma, neoplasm or iatrogenic lesions, such as pulmo- nary artery rupture during right heart artery catheterization. Clinical presentation can range from an incidental finding to a life-threatening bleeding with massive rasmussdn. We present a case of a 67 year old woman with systemic sclerosis that developed massive hemoptysis after right heart catheterization.
Computer tomography angiography showed a pulmonary artery pseudoaneurysm in the posterior basal segmental branch of the left lower lobe. Computer tomography angiography usually allows pseudoaneurysm diagnosis, localization and characterization and can aid sneurismas therapeutic procedure planning.
Pseudoaneurisma da artéria pulmonar: uma lesão vascular rara após cateterismo cardíaco direito
Without treatment pseudoaneurysms may enlarge or rupture. Although a rasmusden complication, pulmonary artery pseudoa- neurysms are associated with high morbidity and mortality, and should not be missed. A pseudoaneurysm is defined as an arterial dilatation that does not comprise all of its wall layers, thus it is at a higher risk of rupture when compared to a true aneurysm. Although rare, pulmonary artery pseudoaneurysms PAP have high morbidity and mortality and should not be missed.
PAPs can have different etiologies depending on what caused the arterial wall damage, such as infection, trau- ma, neoplasm or iatrogenic lesion 1. Tuberculosis, pyogenic bacteria or fungi can cause PAPs.
When secondary to tuber- culosis, they are called Rasmussen aneurysms, usually found in the upper lobes. Mycotic aneurisms and pyogenic bacteria PAPs are more frequently diagnosed in intrave- nous drug users and are associated with endocarditis and septic embolization.
Penetrating thoracic injuries, such as stab or gunshot wounds, are the most common traumatic cause PAP 2. Pulmonary neoplastic lesions, either primary or more rarely secondary, can erode an arterial wall leading to a PAP formation. Iatrogenic lesions are the most frequent cause of PAPs and include right heart and pulmonary artery catheterization, chest tube insertion, pulmonary biopsies and cardiothoracic surgery 3. Dr presentation of a PAP can range from an incidental finding to a life-threatening bleeding with massive hemoptysis.
A 67 year rasmusswn woman, with a background of systemic scle- rosis diagnosed 19 years ago with pulmonary fibrosis, cardiac insufficiency and gastrointestinal involvement, and open-heart aortic biologic valve replacement to treat aortic stenosis inwas referred for an elective right heart catheterization due to pulmonary hypertension.
During the procedure she presented with massive hemoptysis and hemodynamic instability leading to a cardiopulmonary arrest. After tracheal intubation and successful cardiopul- monary resuscitation she was admitted to an intensive care unit.
Two bronchoscopic examinations were performed within 24hours, withoutactivebleedingvisualization. Three days later she presented with a new hemoptysis episode, hemoglobin level drop and hemodynamic instability promp- ting an urgent thoracic computer tomography angiography CTA scan request. Some adjacent bronchi had their lumina filled with content, presu- mably blood.
Bilateral pleural effusion, mediastinal adeno- pathies and esophageal dilatation were noted. The patient evolved favorably aneuirsmas conservative management, and no complications or other hemoptysis episodes were reported.
Four and nine days, respectively, after the first exam, other CTA scans demonstrated aneurysm stability. Pulmonary artery rupture is a rare complication of pulmo- nary artery catheterization.
Rasmussen’s aneurysm: A rare and forgotten cause of hemoptysis
When bleeding is limited by thrombus or surrounding parenchyma, it can lead to a PAP formation. Known risk factors include fema- le and older more than 60 years old patients, steroid use and hypothermia 5. Fibroproliferative vasculopathy and mainly microvascular abnormalities are present in systemic sclerosis 6. A pseudoaneurys misseenasaroundorovalopacity with equivalent enhancement when compared to adjacent vessels, and in continuity with an arterial dee.
This helps to distinguish a PAP from pulmonary infarct or parenchymal consolidation after pulmonary artery catheterization 7. When a patient presents with hemoptysis, urgent CTA is as accurate as bronchoscopy in detecting the site of bleeding 8, helps to identify the underlying cause and the effects of hemorrhage on lung parenchyma. Multiplane reformatted images Fig. The treat- ment of choice is more frequently endovascular emboliza- tion as it is proven to be a safe and effective alternative to surgery Nevertheless, small pseu- doaneurysm may anwurismas successfully managed conservatively Although a rare pathology, pulmonary artery pseudoa- neurysms can have distinct etiologies, namely iatrogenic lesions.
Computer tomography angiography is an excel- lent imaging modality to diagnose and characterize these lesions. Due to pulmonary artery pseudoaneurysms asso- ciation with high morbidity and mortality, they should not be missed. Treatment options include conservative mana- gement and surgical procedures, however endovascular embolization is the current preferred choice.
Pulmonary artery aneurysms and pseudoaneurysms in adults: Quartey B, Jessie E. Pulmonary artery and vein pseudoaneurysm after gunshot wound to the chest. J Emerg Trauma Shock. Etiology, presentation, diagnosis, and treatment.
Rasmussen’s aneurysm: A rare and forgotten cause of hemoptysis
Pulmonary artery rupture associated with the Swan-Ganz catheter. Pulmonary artery false aneurys- ms secondary to Swan-Ganz pulmonary artery catheters.
Vascular involvement in systemic sclerosis scleroderma. False aneurysm of the pulmonary artery induced by a Swan-Ganz catheter: Can CT replace bron- choscopy in the detection of the site and cause of bleeding in patients with large or massive hemoptysis? Immediate transcatheter embolization of Swan-Ganz catheter-induced pulmonary artery pseudoaneurysm.
Endovascular treat- ment of PA pseudoaneurysm caused by Swan-Ganz catheter. Recebido a 02 de novembro de ; Aceite a 11 de dezembro de Como citar este artigo.