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Case Reports
. 2014 Jul 9:2014:bcr2014204673.
doi: 10.1136/bcr-2014-204673.

An unusual case of iatrogenic haemoptysis

Kavita Pal  1 , Vandana Kavita Seeram  2 , James Davis Cury  2
Affiliations
Case Reports

An unusual case of iatrogenic haemoptysis

Kavita Pal et al. BMJ Case Rep. .

Abstract

Summary Transbronchial needle aspiration (TBNA) of the hilar and mediastinal lymph nodes and lung masses is a powerful tool in the diagnostic evaluation of mediastinal adenopathies including malignancies. As its use becomes more widespread, few cases have been reported with complications. We present a case of a 57-year-old man who was transferred to our institution for uncontrolled haemoptysis following endobronchial ultrasound-guided TBNA. At our institution, emergent bronchoscopy revealed a large clot distal to the right upper lobe bronchus without a visible fistula tract. A CT pulmonary angiogram and a subsequent pulmonary angiogram showed an aneurysm originating from the right superior pulmonary vein. Management was conservative with strict blood pressure control and lowering the left atrial pressure allowed spontaneous resolution of the bleed.

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Figures

Figure 1
Figure 1
CT of the chest without contrast performed 1 month prior to the biopsy demonstrating calcified hilar lymphadenopathy and pleural plaque on the left side.
Figure 2
Figure 2
CT angiogram of the chest with coronal views showing aneurysmal dilation originating from the right superior pulmonary vein with subsequent drainage into the left atrium.
Figure 3
Figure 3
CT angiogram of the chest with corresponding axial view showing aneurysmal dilation originating from the right superior pulmonary vein with subsequent drainage into the left atrium with consolidation of the left upper lobe and right lower and middle lobes.
Figure 4
Figure 4
Delayed imaging during right pulmonary angiogram showing the venous return phase, revealing aneurysmal dilation of the right superior pulmonary vein.
See this image and copyright information in PMC

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