Hémoptysie massive sur anévrisme de Rasmüssen

Abstract

The incidence of pulmonary tuberculosis is actually increasing. In active tuberculosis, an aneurysm of the pulmonary artery represents a frequent cause of haemoptysis. In cases of tuberculosis sequelae, the origin of the haemoptysis is often a bronchial artery. We describe the case of a man from Morocco who presented with severe haemoptysis. He was cachectic, had a fever and his chest X-ray showed a cavity in the left lower lobe. CT angiography (MDCTA) showed a Rasmüssen aneurysm of the pulmonary artery. This was occluded with coils, and multi-drug therapy against Mycobacterium tuberculosis was initiated as soon as tuberculosis was diagnosed. Two months later, there was no recurrence of the haemoptysis and repeat the MDCTA showed no opacification of the aneurysm. In patients with severe haemoptysis and evidence of active pulmonary tuberculosis, MDCTA may allow correct identification of the bleeding origin. In our case, the management of the pulmonary aneurysm relied upon pulmonary artery vasoocclusion. This treatment allowed us to wait for the antituberculosis treatment to be effective and reduces the need for a thoracic surgery.