Letter to the Editor
Life-Threatening Hemoptysis Secondary to Rasmussen's Aneurysm in an HIV Patient
Hemoptisis amenazante secundaria a aneurisma de Rasmussen en paciente VIH
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(B) CT volumetric reconstruction (3D or volume rendering) confirming Rasmussen's aneurysm (arrow). (C) Coronal MIP CT reconstruction (pulmonary parenchyma window) showing signs of lung hemorrhage (asterisk) and bilateral residual infectious parenchymal opacities (arrows). (D) Coronal oblique MIP CT reconstruction after embolization showing embolization material (coil) occluding the Rasmussen's aneurysm (arrow).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Life-threatening hemoptysis is a medical emergency defined as the expectoration of over 250<span class="elsevierStyleHsp" style=""></span>ml blood in a 24-h period. If left untreated, mortality is 80%. Most cases originate in hypertrophic bronchial arteries. However, a small percentage of life-threatening hemoptysis occurs in pulmonary arteries weakened by infectious processes caused by mycobacteria or fungi.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 55-year-old man with advanced human immunodeficiency virus infection (stage C3), smoker and former intravenous drug user, who presented at our hospital with life-threatening hemoptysis, hypotension and tachycardia. In addition to emphysema phenotype chronic obstructive lung disease and hepatitis C-related liver cirrhosis, he had had multiple lung infections caused by unusual pathogens (<span class="elsevierStyleItalic">Pneumocystis jirovecii</span>, non-tuberculous mycobacteria, semi-invasive aspergillosis, etc.) that were treated, although treatment adherence was poor. A chest computed tomography (CT) angiography was performed, showing an aneurysm 1<span class="elsevierStyleHsp" style=""></span>cm in diameter in the subsegmentary pulmonary artery of the right lower lobe (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and signs of ipsilateral pulmonary hemorrhage (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C), associated with a Rasmussen's aneurysm. In view of the patient's hemodynamic instability, an angiogram with selective embolization of the aneurysm was performed, achieving complete occlusion of the lesion (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D) and immediate resolution of hemoptysis. No dilation of the bronchial arteries or extravasation of contrast medium from these vessels was observed.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Rasmussen's aneurysm is an uncommon severe complication of pulmonary tuberculosis, with a prevalence of less than 5%. If it ruptures, mortality is over 50%.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Although this complication was first described in 1868 by Fritz Valdemar Rasmussen in patients with tuberculous cavities and hemoptysis, the term “Rasmussen's aneurysm” nowadays has a wider meaning, and includes aneurysm or pseudoaneurysm of the pulmonary arteries in the context of diseases involving destruction of the pulmonary parenchyma.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> These diseases cause progressive weakening of the arterial wall, as the adventitia and media layers are replaced by granulation tissue and fibrin, resulting in thinning of the vessel wall and the risk of pseudoaneurysm formation. CT-angiography is the diagnostic test of choice in patients with hemoptysis: it provides anatomical information on the Rasmussen's aneurysm and the underlying causes and guides the interventional radiologist precisely toward to the aneurysm, while simultaneously studying the bronchial arteries.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> During a chest CT-angiography in patients with hemoptysis, radiologists must observe not only the systemic circulation, but also the pulmonary arteries, particularly in patients with a history of destructive lung diseases. Failure to do so may prevent detection of a Rasmussen's aneurysm, and if the patient finally undergoes an angiogram for treatment of their hemoptysis, the result may be unnecessary embolization of the systemic arteries.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Our case is of interest because, while our patient did not have a history of tuberculosis, the cause of his life-threatening hemoptysis was a Rasmussen's aneurysm associated with his previous history of lung infections.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Oriol AJ, Ayala Carbonero AM, Sarasúa LG. Hemoptisis amenazante secundaria a aneurisma de Rasmussen en paciente VIH. Arch Bronconeumol. 2016;52:439–440.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1350 "Ancho" => 1432 "Tamanyo" => 321017 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Coronal maximum intensity projection (MIP) CT reconstruction, showing a Rasmussen's aneurysm (arrow) on a subsegmentary branch of the right lower lobe artery. (B) CT volumetric reconstruction (3D or volume rendering) confirming Rasmussen's aneurysm (arrow). (C) Coronal MIP CT reconstruction (pulmonary parenchyma window) showing signs of lung hemorrhage (asterisk) and bilateral residual infectious parenchymal opacities (arrows). (D) Coronal oblique MIP CT reconstruction after embolization showing embolization material (coil) occluding the Rasmussen's aneurysm (arrow).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Haemoptysis: diagnosis and treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K. Hurt" 1 => "D. 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Molan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.crad.2011.03.001" "Revista" => array:6 [ "tituloSerie" => "Clin Radiol" "fecha" => "2011" "volumen" => "66" "paginaInicial" => "869" "paginaFinal" => "875" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21658690" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005200000008/v1_201607230336/S1579212916301112/v1_201607230336/en/main.assets" "Apartado" => array:4 [ "identificador" => "49861" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005200000008/v1_201607230336/S1579212916301112/v1_201607230336/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916301112?idApp=UINPBA00003Z" ]
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| 2022 November | 67 | 27 | 94 |
| 2022 October | 98 | 36 | 134 |
| 2022 September | 85 | 41 | 126 |
| 2022 August | 74 | 50 | 124 |
| 2022 July | 96 | 52 | 148 |
| 2022 June | 78 | 55 | 133 |
| 2022 May | 85 | 52 | 137 |
| 2022 April | 94 | 33 | 127 |
| 2022 March | 100 | 60 | 160 |
| 2022 February | 129 | 45 | 174 |
| 2022 January | 116 | 48 | 164 |
| 2021 December | 104 | 52 | 156 |
| 2021 November | 98 | 39 | 137 |
| 2021 October | 112 | 68 | 180 |
| 2021 September | 105 | 74 | 179 |
| 2021 August | 99 | 32 | 131 |
| 2021 July | 102 | 31 | 133 |
| 2021 June | 127 | 33 | 160 |
| 2021 May | 118 | 45 | 163 |
| 2021 April | 196 | 84 | 280 |
| 2021 March | 186 | 26 | 212 |
| 2021 February | 123 | 24 | 147 |
| 2021 January | 96 | 21 | 117 |
| 2020 December | 95 | 14 | 109 |
| 2020 November | 134 | 26 | 160 |
| 2020 October | 190 | 14 | 204 |
| 2020 September | 230 | 21 | 251 |
| 2020 August | 198 | 16 | 214 |
| 2020 July | 227 | 26 | 253 |
| 2020 June | 219 | 8 | 227 |
| 2020 May | 86 | 14 | 100 |
| 2020 April | 98 | 25 | 123 |
| 2020 March | 94 | 17 | 111 |
| 2020 February | 110 | 17 | 127 |
| 2020 January | 107 | 17 | 124 |
| 2019 December | 94 | 14 | 108 |
| 2019 November | 75 | 22 | 97 |
| 2019 October | 78 | 10 | 88 |
| 2019 September | 54 | 14 | 68 |
| 2019 August | 56 | 17 | 73 |
| 2019 July | 50 | 15 | 65 |
| 2019 June | 43 | 14 | 57 |
| 2019 May | 70 | 15 | 85 |
| 2019 April | 94 | 38 | 132 |
| 2019 March | 54 | 15 | 69 |
| 2019 February | 55 | 18 | 73 |
| 2019 January | 55 | 16 | 71 |
| 2018 December | 54 | 25 | 79 |
| 2018 November | 85 | 17 | 102 |
| 2018 October | 93 | 18 | 111 |
| 2018 September | 38 | 14 | 52 |
| 2018 May | 13 | 0 | 13 |
| 2018 April | 47 | 8 | 55 |
| 2018 March | 32 | 0 | 32 |
| 2018 February | 22 | 6 | 28 |
| 2018 January | 80 | 5 | 85 |
| 2017 December | 81 | 2 | 83 |
| 2017 November | 50 | 3 | 53 |
| 2017 October | 23 | 5 | 28 |
| 2017 September | 38 | 15 | 53 |
| 2017 August | 28 | 10 | 38 |
| 2017 July | 31 | 3 | 34 |
| 2017 June | 38 | 18 | 56 |
| 2017 May | 38 | 7 | 45 |
| 2017 April | 26 | 13 | 39 |
| 2017 March | 16 | 7 | 23 |
| 2017 February | 20 | 10 | 30 |
| 2017 January | 28 | 3 | 31 |
| 2016 December | 34 | 20 | 54 |
| 2016 November | 41 | 32 | 73 |
| 2016 October | 1 | 3 | 4 |
Show all
