A70-17 A Bloody Surprise: Unmasking a Pulmonary Artery Pseudoaneurysm in Tuberculosis

Abstract Introduction Pulmonary Artery Pseudoaneurysm (PAP), also known as Rasmussen aneurysm, is a rare complication of tuberculosis. It is an inflammatory pseudo-aneurysmal branch of the pulmonary artery adjacent to a tuberculous cavity. The incidence ranges between 4 and 8% in patients with tuberculous cavitary disease and can lead to massive life-threatening hemoptysis. Case Presentation A 45-year-old woman with type 2 diabetes mellitus and recently diagnosed pulmonary tuberculosis presented to the emergency department with acute, large-volume hemoptysis. She had been hospitalized two weeks earlier for a subacute cough and small-volume hemoptysis. Imaging at that time revealed right upper lobe consolidation, and acid-fast sputum culture was positive for tuberculosis. Despite initial improvement on anti-TB therapy after discharge, she developed intermittent hemoptysis, which was attributed to TB-related airway inflammation.On current presentation, the patient was tachycardic to 128 bpm, hypertensive to 190/95 mmHg, tachypneic to 34 breaths per minute, and had scattered bilateral crackles on exam. A computed tomography angiography (CTA) of the chest revealed a 10 mm enhancing lesion in the right upper lobe consistent with a pulmonary artery pseudoaneurysm, as well as dense consolidation and bilateral pleural effusions. Emergent pulmonary angiography confirmed the pseudoaneurysm, and coil embolization was performed successfully. The hemoptysis resolved, and the patient was discharged with continuation of anti-tubercular therapy. Discussion Pulmonary artery pseudoaneurysms in tuberculosis are exceedingly rare, with a systematic review identifying only 174 reported cases globally over two decades. Yi et al also found that TB-induced aneurysms more commonly rupture between 1.4 and 3 months following symptom onset. That rupture and lack of combined therapy were significant predictors of mortality. Diagnosis requires a high index of suspicion, particularly in patients with tuberculosis who present with hemoptysis exceeding expected severity. CTA is the preferred diagnostic modality, offering precise localization of the lesion. Definitive management typically involves minimally invasive intervention via endovascular embolization or coiling, which is both diagnostic and therapeutic. This case highlights the importance of considering PAP in the differential diagnosis of hemoptysis in patients with TB. Early recognition and timely interventional radiology consultation are crucial, as delay can result in catastrophic hemorrhage. This abstract is funded by: None