A71-02 Rasmussen Aneurysm, A Rare Complication Of Tuberculosis: A Systematic Review And Meta-analysis

Rationale

Rasmussen aneurysm (RA) is a rare pseudoaneurysmal dilation of the bronchial artery that most commonly arises as a potentially fatal complication of pulmonary tuberculosis (TB). It most commonly presents with hemoptysis as the cardinal clinical manifestation. Due to its rarity and the absence of standardized diagnostic or management protocols, this condition is often underdiagnosed. This study represents the first systematic review and meta-analysis to comprehensively characterize the clinical, radiological, and therapeutic features of RA and to identify predictors of clinical improvement.

Methods

PubMed, Scopus, and Web of Science were searched in July 2025 to include all studies on RA without language or date restrictions. Any study lacking individual patient data or insufficient clinical information was excluded. Demographic, clinical, laboratory, and radiological data, along with treatment interventions and outcomes, were extracted and then analyzed. The PROSPERO registration number is CRD420251109349.

Results

We screened 565 studies, and 107 met inclusion criteria, with a total of 117 patients. The mean age was 45.7 ± 17.9 years, with 75.4% of patients being male. Hemoptysis was the predominant presenting symptom (92.3%), followed by cough (52.1%), fever (36.8%), dyspnea (23.1%), and weight loss (22.2%). Active TB was present in 61.5% of patients, and these patients had better clinical outcomes (47.6% vs. 69.3%, p = 0.014). For imaging, All patients (100%) demonstrated abnormal findings on both conventional CT and CT angiography. Most patients had a single aneurysm (77.8%), with a mean diameter of 30 ± 24.5 mm. The left upper lobe was the most common site (60%). The aneurysm location coincided with tuberculosis cavitation 91.9% of patients, underscoring a strong anatomical association. Endovascular embolization was the primary therapeutic intervention (62.4%) and was associated with significantly higher rates of clinical improvement (42.9% vs. 73.7%, p = 0.032). Initiation of anti-TB therapy after diagnosis was the strongest predictor of improvement (26.2% vs. 73.7%, p < 0.001). In contrast, larger aneurysm size (40.2 vs. 24.5mm, p = 0.023) and the presence of dyspnea at presentation (35.7% vs. 16%, p = 0.029) were associated with poorer outcomes. Overall, 63.2% of patients improved, while 14.5% of patients ultimately died, and 3.4% experienced worsening symptoms.

Conclusion

RA is a rare yet serious complication of pulmonary TB. The pivotal imaging modality of RA diagnosis remains CTA, while combined endovascular embolization and anti-TB medications are the keys to a better prognosis. Our findings provide a more in-depth understanding of RA and treatment modalities.

This abstract is funded by: None