Case 2: A 30 year old male presented to our institute with history of fever, night sweats, and productive cough since 1 year. It was associated with weight loss. After thorough clinical, radiological examination, positive sputum and culture for TB mycobacteria, patient was finally diagnosed with tuberculosis. Patient was treated with anti-tubercular drugs for 6 months. After 2 months of completion of treatment, the patient developed excessive coughing along with massive haemoptysis (roughly 300 ml/hr) for 2 days. Subsequently the patient was brought to the emergency room with a GCS ( Glasgow coma scale )of 10 of 15. His vitals were stabilized and patient was further evaluated by laboratory and radiological examinations. Mild decrease in haemoglobin level was documented. However other blood parameters were within the normal limits. A chest radiograph revealed a cavitating lesion involving the upper zone of the left lung. The patient underwent a CT pulmonary angiogram, which demonstrated an irregular shaped cavity measuring ~ 7 x 3.5 x 6.5cm in apico-posterior segment of left upper lobe (wall thickness~ 12mm). Non-enhancing dependant content was seen within the cavity. Extensive areas of fibrobronchiectasis were noted in adjoining lung parenchyma in left upper lobe. Few centrilobular nodules were seen in left lower lobe with surrounding ground glass opacity. No active extravasation of contrast was seen. Multiple focally dilated sub-segmental division of left upper lobe pulmonary artery which were seen coursing along the periphery of the cavitary lesion representing Rasmussen aneurysm. Bronchial arteries were normally visualized (Fig. 1, Fig. 5, Fig. 6, Fig. 7).
Patient was then transferred to the interventional radiology department for further management of the aneurysm. The patient was taken to DSA for embolization of the pulmonary artery to halt the source of bleed. The right common femoral vein approach was used in combination with a pigtail catheter and guidewire access, into the pulmonary trunk and subsequently to the left pulmonary artery. Selective angiogram revealed multiple focally dilated pulmonary artery. The patient underwent glue embolization of the aneurysms and remained stable without further haemoptysis.