Uncommon source of haemoptysis in pulmonary tuberculosis: intercostal artery pseudoaneurysm

Pulmonary tuberculosis (TB) is one of the most common infectious diseases prevalent in developing countries and can cause life-threatening haemoptysis. The primary sources of haemoptysis in pulmonary TB are the bronchial and pulmonary arteries; however, non-bronchial systemic arteries, such as the intercostal arteries, can also be potential sources of massive haemoptysis. Cases of life-threatening haemoptysis arising from an intercostal artery pseudoaneurysm in patients with pulmonary TB, however, remain underreported.We hereby describe a case of a middle-aged man who was diagnosed with pulmonary tuberculosis on anti-tubercular therapy and is currently in the continuation phase of treatment presented with recurrent episodes of haemoptysis, where CT thoracic angiography of the chest revealed contrast-filled outpouching into right upper lobe cavitary lesion with multiple prominent subsegmental branches of the pulmonary artery. However, a catheter angiogram also revealed tortuous vessels supplying abnormal parenchyma and a pseudoaneurysm arising from the right third intercostal artery, which was managed subsequently by endovascular embolisation. Intercostal artery pseudoaneurysms are uncommon but a clinically significant cause of haemoptysis in patients with pulmonary tuberculosis. Despite their rarity, these vascular complications carry a high risk of morbidity and mortality if not promptly recognised and managed.