Hemoptysis in Pulmonary Tuberculosis Complicated by Rasmussen’s Pseudoaneurysm. A Pediatric Case Report.
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Abstract
We present the case of a 12-year-old boy admitted to the hospital due to hemoptysis without other symptoms. We performed a Thorax X-Ray (pathological), laboratory with elevated acute phase reactants, TST (negative), sputum x 3 with negative smear and computed tomography angiography showing a tree-in-bud pattern in all lobes, and dilatation of a brunch of the pulmonary artery in the upper left lobe. We considered primary vascular anomaly or lesion due to infection as a differential diagnosis. The patient underwent digital angiography and therapeutic embolization of this pseudoaneurysm. After seventeen days, 2/3 of the sputum cultures were positive for Mycobacterium tuberculosis. The patient received standard anti-TB therapy with favorable evolution.
This case highlights the importance of considering complications such as Rasmussen's pseudoaneurysm in patients with pulmonary tuberculosis and recurrent or massive hemoptysis.
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References
Robaldo JF. Capítulo 69: Hemóptisis. Enfermedades respiratorias pediátricas. McGraw-Hill, 2003, pp. 663–6.
Cordovilla R, de Miguel EB, Ares AN et al. Diagnóstico y tratamiento de la hemoptisis. Arch Bronconeumol 2016:368–77. Doi: 10.1016/j.arbres.2015.12.002.
Shnayder R, Needleman JP. Hemoptysis. Pediatr Rev 2018:319–21. Doi: 10.1542/pir.2017-0157.
González Fernández A, Torres Torres AR, Valverde Molina J. Traumatismo torácico, neumotórax, hemoptisis y tromboembolismo pulmonar. Protoc Diagn Ter Pediatr 2017;1:189-209.
Godfrey S. Pulmonary hemorrhage/hemoptysis in children. Pediatr Pulmonol 2004;37:476–84. Doi: 10.1002/ppul.20020.
Gaude GS. Hemoptysis in children. Indian Pediatr 2010;47:245–54. Doi: 10.1007/s13312-010-0044-z.
Ministerio de Salud de la Nación Argentina. Boletín N° 6: Tuberculosis y Lepra en la Argentina. [Internet]. [Consultado 14 May 2023]. Disponible en: https://bancos.salud.gob.ar/recurso/boletin-ndeg-6-tuberculosis-y-lepra-en-la-argentina
Comité Nacional de Neumología, Comité Nacional de Infectología et al. Criterios de diagnóstico y tratamiento de la tuberculosis infantil. Arch Argent Pediatr (n.d.) [Internet]. [Consultado 14 May 2023]. Disponible en: https://www.sap.org.ar/uploads/consensos/criterios-de-diagn-oacutestico-y-tratamiento-de-la-tuberculosis-infantil-nbsp2016.pdf
Böncüoğlu E, Çınar C, Kıymet E. A rare complication of pulmonary tuberculosis in childhood: Rasmussen`s aneurysm in a 9-year-old child with Down syndrome. Turk J Pediatr 2022;64:408–11.Doi: 10.24953/turkjped.2021.1617.
Santelli ED, Katz DS, Goldschmidt AM et al. Embolization of multiple Rasmussen aneurysms as a treatment of hemoptysis. Radiology 1994;193:396–8. Doi: 10.1148/radiology.193.2.7972750.
Yu MWL, Li AM, Lai MH et al. Rare but life-threatening cause of massive haemoptysis in an adolescent with tuberculosis: Rasmussen’s aneurysm. BMJ Case Rep 2023;16. Doi: 10.1136/bcr-2023-255480.
Gallardo MEA. Giant Rasmussen’s aneurysm in a 9-year-old boy: A case report. Radiol Case Rep 2022;17:4168–75. Doi: 10.1016/j.radcr.2022.08.016.
Gandhi S, Jaiswal A, Joshi S et al. Rasmussen’s Aneurysm in a Child with Multidrug Resistant Pulmonary Tuberculosis. Indian J Pediatr 2020;87:564. Doi: 10.1007/s12098-020-03211-4.
Gesuete V, Corzani A, Bronzetti G et al. Rasmussen’s aneurysm in childhood: a case report. Congenit Heart Dis 2013;8:E41–4. Doi: 10.1111/j.1747-0803.2011.00609.x.
Kim HY, Song KS, Goo JM et al. Thoracic sequelae and complications of tuberculosis. Radiographics 2001;21:839–58. Doi: 10.1148/radiographics.21.4.g01jl06839.
Nguyen ET, Silva CIS, Seely JM et al. Pulmonary artery aneurysms and pseudoaneurysms in adults: findings at CT and radiography. Am J Roentgenol 2007;188:W126–34. Doi: 10.2214/AJR.05.1652.
Remy J, Lemaitre L, Lafitte JJ et al. Massive hemoptysis of pulmonary arterial origin: diagnosis and treatment. Am J Roentgenol 1984;143:963–9. Doi: 10.2214/ajr.143.5.963.
Mariani E, Marmo G, Manfrin L. Tuberculosis Pulmonar. In: Fundación Hospital de Pediatría Dr. J. P. Garrahan. Medicina Interna Pediátrica 2022; 14.
Peghini Gavilanes E, Fernández-Velilla M, Bermejo Moriñigo A et al. Pseudoaneurisma de Rasmussen: hallazgos en tomografía computada. Revisión de casos. Rev Argent Radiol 2016;80:122–6. Doi: 10.1016/j.rard.2016.03.004.
Meiler S, Hamer OW, Blaas S et al. Rasmussen Aneurysm: A Forgotten Complication. Am J Respir Crit Care Med 2023;207:206–7. Doi: 10.1164/rccm.202201-0192IM.