Open AccessAmbiguous presentation of Mycobacterium avium complex‐associated Rasmussen aneurysm
Author(s) -
Chiu HsinWei,
Kuo ShuHung,
Lai RuaySheng,
Wu MingTing,
Wu HsiuFu
Publication year - 2017
Publication title -
respirology case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.304
H-Index - 9
ISSN - 2051-3380
DOI - 10.1002/rcr2.219
Subject(s) - medicine , radiology , ethambutol , bronchial artery , angiography , embolization , aneurysm , catheter , computed tomography angiography , lesion , tuberculosis , mycobacterium tuberculosis , surgery , pathology
A 77‐year‐old man with a progressively dry cough (two months duration) was admitted with hemoptysis. Chest computed tomography ( CT ) revealed left lingular lobe consolidation and one thick‐walled cavity lesion over the left lower lobe, which was accompanied by satellite micro‐nodules in a tree‐in‐bud pattern. CT ‐guided biopsy confirmed mycobacterial infection, and subsequent culture yielded Mycobacterium avium complex ( MAC ). Unremitting hemoptysis was present despite treatment (14 days) with ethambutol, rifampin, clarithromycin, and streptomycin. Initial CT angiography ( CTA ) to determine the source of the hemoptysis revealed a suspected aneurysm in the consolidated left lingular lobe; however, this could not be localized via catheter angiography during the pulmonary and bronchial arterial phases. Two weeks later, a massive hemoptysis episode led to haemodynamic instability and serious consequences. Follow‐up CTA confirmed the previously detected aneurysm, and glue embolization was performed successfully. This case report highlights a rare but catastrophic MAC ‐associated pseudoaneurysm and relevant treatment options.