Introduction: Rasmussen's Aneurysm is a very rare complication of pulmonary tuberculosis which is caused by the weakening of the pulmonary artery wall from adjacent cavitary tuberculosis. It can be life-threatening if not treated expeditiously.

Aims and objectives: describe manifestations and management of Rasmussen Aneurysm

Methods: We report 12 cases of Rasmussen?s aneurysm seen between 2015 and 2023 in three pulmonology departments (2, 3, C) of Abderrahman Mami Hospital in TUNISIA

Results: There were 11 males and 1 female. The mean age was 45 years [18 to 68 years]. Eleven were smokers. Hemoptysis was the common presenting symptom. Six patients had massive hemoptysis and needed a blood transfusion. Five presented with acute respiratory failure. Thoracic CT scans allowed the diagnosis in all patients. The mean size of the aneurysm was 8 mm [2?16 mm].

The mean delay between the diagnosis of tuberculosis and Rasmussen aneurysm identification was 10 days. In 6 cases, the two diagnoses were made at the same time.

Aneurysm localizations were: the upper left lobe in 5 cases, the left lower lobe in 3 cases, the right lower lobe in 2 cases, the right upper lobe in 1 case, and the right middle lobe in 1 case.

Five patients required emergent embolization that was successful in 3 cases. Urgent hemostatic surgery was performed in 2 cases (right bi-lobectomy in one case and left upper lobectomy in one case). One patient died from cataclysmic hemoptysis.

After one year, 7 patients had a favorable outcome and 4 patients were lost in follow-up.

Conclusion: Although rare, Rasmussen Aneurysm commonly manifests as a life-threatening massive hemoptysis. Timely diagnosis and urgent management are mandatory to improve prognosis.