An Unusual Vascular Threat in Tuberculosis: Strategic Control of Rasmussen Aneurysm Bleeding

Abstract Rationale: Rasmussen aneurysms, rare pseudoaneurysms of the pulmonary or bronchial artery, often develop in association with cavitary tuberculosis (TB) and carry a high risk of life-threatening hemoptysis. Rapid diagnosis and targeted intervention are essential for effective management, yet there is limited guidance on optimal therapeutic approaches. This case series highlights the clinical presentation, diagnostic workup, and treatment outcomes in three patients with TB-associated Rasmussen aneurysms, emphasizing strategies for controlling hemorrhage and preventing recurrence. Methods: We conducted a retrospective review of three patients (ages 20, 23, and 31) presenting with massive hemoptysis due to confirmed Rasmussen aneurysms. Each case involved detailed clinical and imaging evaluation, including computed tomography angiography (CTA) to assess aneurysm characteristics and bleeding risk. Therapeutic interventions consisted of endovascular embolization with liquid embolic agents in one case, and coil assisted glue embolization in another, with outcomes measured in terms of symptom resolution, recurrence, and follow-up findings. Patient adherence to anti-tuberculosis treatment was also recorded. Results: All patients presented with moderate to severe hemoptysis and imaging-confirmed cavitary lesions with Rasmussen aneurysms:• Patient 1 (21 years old): A 4x4 mm aneurysm in the right upper lobe was identified and treated with coil assisted glue embolization, achieving stable symptom control, with one episode of recurrence at follow-up.• Patient 2 (31 years old): Severe hemoptysis and recurrent respiratory instability were observed. CTA revealed a 6.5 mm aneurysm in a cavitary lesion of a destroyed lung, treated with liquid agent embolization, achieving temporary control; however, a high recurrence risk remains due to extensive cavitation.• Patient 3 (23 years old): Presented with massive hemoptysis and a right apical lobe aneurysm on CTA. Embolization, combined with anti-TB therapy, led to sustained improvement without recurrence.Key Findings:CTA as Primary Diagnostic Tool: CTA efficiently localized and diagnosed aneurysms as small as 4mm.Efficacy of Embolization: Endovascular liquid agent embolization achieved effective immediate hemorrhage control in all cases, with recurrence minimal in patients with limited cavitation.Impact of Anti-TB Therapy: Delayed or inconsistent anti-TB therapy appeared to correlate with increased aneurysm-related complications, suggesting early TB treatment may reduce vascular risks. Conclusion: This series underscores the efficacy of CTA for diagnosing Rasmussen aneurysms and the success of liquid agent embolization in controlling hemoptysis. Delayed or incomplete TB treatment correlated with more severe aneurysmal disease, suggesting that prompt and sustained anti-TB therapy may reduce vascular complications. These findings advocate for standardized imaging and intervention protocols in TB-endemic areas to improve patient outcomes and reduce mortality associated with aneurysmal hemoptysis.