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Case Reports
. 2019 Nov;33(6):2718-2724.
doi: 10.1111/jvim.15640. Epub 2019 Oct 30.

Fatal hemoptysis after bronchoscopic biopsy in a dog

Clayton Greenway  1 , Elizabeth Rozanski  1 , Kelsey Johnson  1 , Lilian Cornejo  1 , Amanda Abelson  1 , Nicholas Robinson  2
Affiliations
Case Reports

Fatal hemoptysis after bronchoscopic biopsy in a dog

Clayton Greenway et al. J Vet Intern Med. 2019 Nov.

Abstract

An 8-year-old 24.6 kg mixed breed dog underwent bronchoscopy for evaluation of a persistent progressive cough. Bronchoscopy documented a markedly thick and irregular, cobblestone appearance of the mucosa. A bronchoscopic biopsy was obtained; immediately after the biopsy, a large amount of hemorrhage poured from the endotracheal tube. Multiple efforts to control the hemorrhage were unsuccessful and the dog suffered a cardiopulmonary arrest and could not be revived. A necropsy was performed, which was significant for pallor, evidence of prior heartworm disease, prominent bronchial arteries, and erosion of the submucosal vessels at the site of the biopsy. The cause of death was hemorrhage associated with transbronchial biopsy of an enlarged bronchial artery associated with heartworm disease. This report describes a rare complication of a routine diagnostic procedure.

Keywords: bronchoscopy; heartworm; hemoptysis; iatrogenic complication; massive transfusion.

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Conflict of interest statement

Authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Bronchoscopic view of thickened and irregular mucosa and submucosa at the level of the carina. Right side of the image is the left side of the dog
Figure 2
Figure 2
Transverse arterial phase slices of thoracic CT‐angiogram in lung and soft tissue windows. A‐C, Our patient; D‐F, comparative images of a dog presented for reasons unrelated to the cardiopulmonary system. C and F are magnifications of the inset in B and E, respectively. Note the tortuous and ramified pulmonary arteries in A‐C. The right caudal pulmonary bronchus is lined with distended arteries in C, visible as end‐on contrast‐filled foci (arrows), which are not present in the normal dog in F. There is intraluminal material within this same bronchus in C, consistent with clot from hemorrhage. Asterisk, bronchial lumen; Ca, caudal vena cava; E, esophagus
Figure 3
Figure 3
In situ appearance of clot in tracheal and main‐stem bronchi at necropsy examination
Figure 4
Figure 4
Gross view of the trachea and main‐stem bronchi after removal of the clot. The suspected biopsy site is shown by an arrow; this was subsequently evaluated by histopathology
Figure 5
Figure 5
Tracheal biopsy site. A, The tissue disruption and deficit left by removing the biopsy (asterisk) shows a gap between the tracheal cartilage rings with the deepest aspect of the biopsy site overlaying a superficial artery (presumptive branch of the tracheal artery, arrowhead). H&E, bar = 500 μm. B, The tracheal mucosa adjacent to the biopsy site has multifocal regions of epithelial necrosis with underlying submucosal edema and infiltration of neutrophils. H&E, bar = 500 μm
See this image and copyright information in PMC

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