Catastrophic pulmonary haemorrhage after endobronchial biopsy of necrotic lung mass

Flexible bronchoscopy (FB) is instrumental in the diagnosis and treatment of respiratory illness, with low rates of bleeding post-procedure but unpredictable degrees of severity. Although exceedingly rare, massive pulmonary haemorrhage after FB is often catastrophic. We present a case of massive pulmonary haemorrhage after endobronchial biopsy of a 67-year-old patient with a prior diagnosis of right upper lobe (RUL) necrotic lung mass. Imaging revealed possible lymphangitic carcinomatosis and tumour invasion into the lymphatics and vasculature. Significant RUL tumour burden was visualized during the procedure, however, routine endobronchial biopsy resulted in massive pulmonary haemorrhage leading to pulseless electrical activity. Prevention of massive pulmonary haemorrhage may be possible with identification of known risk factors. Catastrophic outcomes from massive pulmonary haemorrhage remain high despite current therapies. Further studies identifying modifiable risk factors, treatment protocols, and the formulation of a multi-disciplinary action plan could prove lifesaving.