A 55-year-old man with known active pulmonary TB (sputum AFB 3+) develops sudden onset severe haemoptysis (~600 mL). Emergency bronchial angiography reveals a dilated aneurysmal vessel within the right upper lobe cavity — most likely a Rasmussen aneurysm. The FIRST-LINE intervention is:
- A Bronchial artery embolisation (BAE) ✓
- B Emergency pneumonectomy
- C Bronchoscopic cold saline lavage and adrenaline instillation
- D IV tranexamic acid and conservative management
Explanation
A Rasmussen aneurysm is a pseudoaneurysm of a pulmonary artery branch within a tuberculous cavity caused by inflammatory erosion of the vessel wall, and is a classic cause of massive haemoptysis in TB. Bronchial artery embolisation (BAE) is the first-line intervention for massive haemoptysis in TB, effective in 73-98% of cases as an immediate haemostatic measure. Emergency pneumonectomy has high mortality in this context and is reserved for failed BAE or recurrent haemoptysis after BAE in surgically fit patients. Bronchoscopic measures are adjuncts for small-volume bleeding. Tranexamic acid may be a supplement but does not address the vascular lesion.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.