INTRODUCTION: Rasmussen’s aneurysm (RA) is a rare but life-threatening vascular complication of pulmonary tuberculosis (PTB), involving pseudo-aneurysmal dilation of pulmonary arteries adjacent to tuberculous cavities. The rupture of RA can lead to massive hemoptysis, contributing to high mortality in PTB patients. This case highlights a post-tubercular patient with RA, pulmonary hypertension, and cor pulmonale, emphasizing the need for early recognition and management.

CASE PRESENTATION: A 60-year-old female with a history of PTB (treated in the 1980s) presented with progressive dyspnea, right-sided heart failure, and massive hemoptysis. Chest radiography, echocardiography, and computed tomography angiography (CTA) revealed pulmonary hypertension, RA, and extensive post-tubercular lung damage. The patient was treated with tranexamic acid, vasodilators, and mechanical ventilation. Despite initial stabilization, she continued to experience severe hemoptysis and respiratory collapse. The family opted for comfort care, and the patient demised despite optimal interventions.

DISCUSSION: Rasmussen’s aneurysm is a rare but serious vascular complication of tuberculosis. It results from chronic inflammation and vascular damage in pulmonary arteries adjacent to tuberculous cavities. Although bronchial artery involvement is the most common cause of hemoptysis, RA accounts for less than 10% of cases and is often overlooked. This case underscores the importance of distinguishing RA from other causes of hemoptysis. Pulmonary hypertension and cor pulmonale, frequently observed in chronic lung diseases like PTB, exacerbate the severity of aneurysm rupture and complicate management. Early imaging, such as CTA, is essential for timely diagnosis, as RA's rupture carries a high mortality rate due to rapid progression and difficulty controlling hemorrhage. The patient's deterioration despite aggressive therapy highlights the challenges in managing hemoptysis in patients with comorbidities such as cor pulmonale. Early recognition, imaging, and prompt intervention are critical in improving outcomes and reducing mortality in affected patients.  

Dr. Loren D.C. Gabayeron is a Fellow in Adult Cardiology at the Heart and Vascular Institute of Perpetual Help Medical Center Las Piñas, Philippines, where she previously served as Chief Fellow. She has presented multiple case reports and research outputs at both national and international scientific meetings, earning recognition for her clarity, relevance, and scholarly rigor.

She is currently pursuing further subspecialty training in Echocardiography, with a strong focus on integrating research and advanced imaging in the diagnostic workup of complex cardiovascular conditions. She upholds a commitment to leadership, mentorship, and the promotion of academic excellence in cardiovascular medicine.