Anatomically remote endobronchial haemorrhage after EBUS-TBNA.

Area of Science:

• Pulmonology
• Interventional Pulmonology
• Diagnostic Procedures

Background:

• Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a standard diagnostic tool for mediastinal and lung lesions.
• While generally safe, EBUS-TBNA carries risks of complications like bleeding, pneumothorax, and infection.
• Airway bleeding is typically linked to the puncture site or lesion itself.

Purpose of the Study:

• To report a rare case of endobronchial hemorrhage during EBUS-TBNA.
• To describe an unusual bleeding source anatomically distant from the needle insertion site.
• To emphasize the need for emergency protocols in managing unexpected EBUS-TBNA complications.

Main Methods:

• A patient undergoing EBUS-TBNA for a right hilar mass.
• Needle insertion via the posterior mid-trachea with ultrasound and Colour Doppler guidance.
• Observation and management of unexpected endobronchial bleeding.

Main Results:

• Active bleeding originated from the posterior segment of the right upper lobe bronchus, distant from the tracheal puncture site.
• The bleeding was suspected to be intralesional hemorrhage with an airway communication.
• The complication was identified and managed effectively without escalation.

Conclusions:

• This is the first reported case of anatomically remote endobronchial bleeding during EBUS-TBNA.
• The event suggests potential intralesional bleeding communicating with a distant airway.
• Highlights the critical importance of preparedness for rare, severe complications during EBUS-TBNA.