Abstract Background/Introduction Rasmussen aneurysms are abnormalities of the pulmonary arterial system caused by tuberculosis (TB). They are associated with a high mortality rate when they cause life-threatening haemoptysis. Massive haemoptysis in high TB-prevalence regions is often due to systemic bronchial artery feeders and this has traditionally been to first target for intervention. Our unit initiated a policy of routine computed tomography pulmonary angiogram (CTPA) for patients with haemoptysis and diagnosed a large number of Rasmussen aneurysms. We describe the first series of these lesions treated with Amplatzer vascular plugs in a cohort of 27 patients. Methods This series of 27 patients who presented with life-threatening haemoptysis from current and/or previous TB were found to have abnormal pulmonary arteries on CTPA, which were judged to be likely contributors to their bleeding, either in isolation or with concomitant abnormal bronchial or systemic vasculature. They underwent transcatheter placement of Amplatzer vascular plugs in the feeder pulmonary artery. See Illustrative case image attached: (A) and (B) CTPA confirming a large left upper lobe cavity with evidence of a Rasmussen’s aneurysm at the medial border of the cavity (red arrow).(C) Selective injection of the feeding artery of the aneurysm depicting bleeding from the ruptured aneurysm (blue arrow). (D) Contrast injection outside the feeding artery confirming no anterograde flow beyond the Amplatzer vascular plug (green arrow). Results Bronchial and systemic lesions were addressed separately as needed. Immediate technical success was achieved in all patients, but four of them experienced intraoperative haemoptysis related to dislodgement of the occluding platelet plug by the wire or contrast injection. At 48 hours after the procedure, 20 (74%) remained haemoptysis-free. Six of these experienced recurrence within 1 year of their procedure, often precipitated by ongoing or re-infection with TB, rifampicin induced thrombocytopenia or aspergilloma. Conclusion(s) Pulmonary artery placement of an Amplatzer vascular plug is a feasible option for treating bleeding Rasmussen aneurysms, but should be part of a combined approach including bronchial artery interventions and surgery to addressing haemoptysis in patients with TB.An illustrative case of a Rasmussen ane
Weich et al. (Sat,) studied this question.