Rasmussen aneurysm
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- updated 11 May 2022:
Nothing to disclose
Updates to Article Attributes
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Rasmussen aneurysm is an uncommon complication of pulmonary tuberculosis and represents a pulmonary artery aneurysm adjacent or within a tuberculous cavity.
It is not to be confused with Rasmussen encephalitis.
Epidemiology
It can be present in up to 5% of patients with chronic cavitary tuberculosis on autopsy.
Clinical presentation
Haemoptysis is the usual presenting symptom and may be life-threatening when it is massive.
Pathology
A weakening of the pulmonary artery wall from adjacent cavitary tuberculosis is the cause of this condition: there is a progressive weakening of the arterial wall as granulation tissue replaces both the adventitia and the media. This is then gradually replaced by fibrin, resulting in thinning of the arterial wall, pseudoaneurysm formation, and subsequent rupture with haemorrhage.
Location
Usually distributed peripherally and beyond the branches of the main pulmonary arteries 2.
Radiographic features
CT
CT pulmonary angiography is the investigation of choice 4. Often seen on contrasted chest images as a focal dilatation of one of the pulmonary segmentary arteries adjacent to tuberculous parenchymal change or a chronic tuberculous cavity.
History and etymology
It is named after Danish physician Fritz Valdemar Rasmussen (1837-1877).
Differential diagnosis
It is almost pathognomonic if present in the right clinical content and in the vicinity of a tuberculous cavity.
In atypical cases consider:
- vasculitis (can be an aneurysm or pseudoaneurysm)
-
pulmonary artery pseudoaneurysm
- iatrogenic, e.g. injury from a Swan-Ganz catheter
- mycotic aneurysm: especially in intravenous drug users
-<p><strong>Rasmussen aneurysm</strong> is an uncommon complication of <a href="/articles/tuberculosis-pulmonary-manifestations-1">pulmonary tuberculosis</a> and represents a <a href="/articles/pulmonary-arterial-aneurysm">pulmonary artery aneurysm</a> adjacent or within a tuberculous cavity.</p><p>It is not to be confused with <a href="/articles/rasmussen-encephalitis">Rasmussen encephalitis</a>.</p><h4>Epidemiology</h4><p>It can be present in up to 5% of patients with chronic cavitary tuberculosis on autopsy. </p><h4>Clinical presentation</h4><p><a href="/articles/haemoptysis-1">Haemoptysis</a> is the usual presenting symptom and may be life-threatening when it is massive. </p><h4>Pathology</h4><p>A weakening of the pulmonary artery wall from adjacent cavitary tuberculosis is the cause of this condition: there is a progressive weakening of the arterial wall as granulation tissue replaces both the adventitia and the media. This is then gradually replaced by fibrin, resulting in thinning of the arterial wall, pseudoaneurysm formation, and subsequent rupture with haemorrhage. </p><h5>Location</h5><p>Usually distributed peripherally and beyond the branches of the main pulmonary arteries <sup>2</sup>.</p><h4>Radiographic features</h4><h5>CT</h5><p>CT pulmonary angiography is the investigation of choice <sup>4</sup>. Often seen on contrasted chest images as a focal dilatation of one of the pulmonary segmentary arteries adjacent to tuberculous parenchymal change or a chronic tuberculous cavity.</p><h4>History and etymology</h4><p>It is named after Danish physician <strong>Fritz Valdemar Rasmussen</strong> (1837-1877).</p><h4>Differential diagnosis</h4><p>It is almost pathognomonic if present in the right clinical content and in the vicinity of a tuberculous cavity. </p><p>In atypical cases consider:</p><ul>-<li>vasculitis (can be an aneurysm or pseudoaneurysm)<ul>-<li><a href="/articles/behcet-disease-2">Behcet disease</a></li>-<li><a href="/articles/hughes-stovin-syndrome">Hughes-Stovin syndrome</a></li>-</ul>-</li>-<li>-<a href="/articles/pulmonary-artery-pseudoaneurysm">pulmonary artery pseudoaneurysm</a> <ul><li>iatrogenic, e.g. injury from a <a href="/articles/pulmonary-artery-catheter">Swan-Ganz catheter</a>-</li></ul>-</li>-<li>-<a href="/articles/mycotic-aneurysm">mycotic aneurysm</a>: especially in <a href="/articles/intravenous-drug-user">intravenous drug users</a>-</li>- +<p><strong>Rasmussen aneurysm</strong> is an uncommon complication of <a href="/articles/tuberculosis-pulmonary-manifestations-1">pulmonary tuberculosis</a> and represents a <a href="/articles/pulmonary-arterial-aneurysm">pulmonary artery aneurysm</a> adjacent or within a tuberculous cavity.</p><p>It is not to be confused with <a href="/articles/rasmussen-encephalitis">Rasmussen encephalitis</a>.</p><h4>Epidemiology</h4><p>It can be present in up to 5% of patients with chronic cavitary tuberculosis on autopsy. </p><h4>Clinical presentation</h4><p><a href="/articles/haemoptysis-1">Haemoptysis</a> is the usual presenting symptom and may be life-threatening when it is massive. </p><h4>Pathology</h4><p>A weakening of the pulmonary artery wall from adjacent cavitary tuberculosis is the cause of this condition: there is a progressive weakening of the arterial wall as granulation tissue replaces both the adventitia and the media. This is then gradually replaced by fibrin, resulting in thinning of the arterial wall, pseudoaneurysm formation, and subsequent rupture with haemorrhage. </p><h5>Location</h5><p>Usually distributed peripherally and beyond the branches of the main pulmonary arteries <sup>2</sup>.</p><h4>Radiographic features</h4><h5>CT</h5><p>CT pulmonary angiography is the investigation of choice <sup>4</sup>. Often seen on contrasted chest images as a focal dilatation of one of the pulmonary segmentary arteries adjacent to tuberculous parenchymal change or a chronic tuberculous cavity.</p><h4>History and etymology</h4><p>It is named after Danish physician <strong>Fritz Valdemar Rasmussen</strong> (1837-1877).</p><h4>Differential diagnosis</h4><p>It is almost pathognomonic if present in the right clinical content and in the vicinity of a tuberculous cavity. </p><p>In atypical cases consider:</p><ul>
- +<li>vasculitis (can be an aneurysm or pseudoaneurysm)<ul>
- +<li><a href="/articles/behcet-disease-2">Behcet disease</a></li>
- +<li><a href="/articles/hughes-stovin-syndrome">Hughes-Stovin syndrome</a></li>
- +</ul>
- +</li>
- +<li>
- +<a href="/articles/pulmonary-artery-pseudoaneurysm">pulmonary artery pseudoaneurysm</a> <ul><li>iatrogenic, e.g. injury from a <a href="/articles/pulmonary-artery-catheter">Swan-Ganz catheter</a>
- +</li></ul>
- +</li>
- +<li>
- +<a href="/articles/mycotic-aneurysm">mycotic aneurysm</a>: especially in <a href="/articles/intravenous-drug-user">intravenous drug users</a>
- +</li>
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Image 3 CT (C+ arterial phase) ( create )
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Case 3
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