No Time to Bleed! Ultrasound-Guided Management of a Pleural Biopsy Complication: A Case Report

Malignant pleural disease is a clinical condition of growing health importance, often presenting as pleural thickening and/or malignant pleural effusion. Rapid and accurate diagnosis is crucial to guide treatment decisions. In most cases, pleural biopsy is necessary: thoracoscopy, ultrasound- and CT-guided biopsies all offer high accuracy and good safety. The use of ultrasound has revolutionised procedural approaches, increasing safety thanks to its good sensitivity and very high specificity, allowing direct and immediate visualisation of complications such as pneumothorax or haemorrhage. In this case report, we describe how intrapleural adrenaline instillation successfully controlled pleural haemorrhage, which was identified as a complication of ultrasound-guided pleural biopsy thanks to real-time ultrasound and colour Doppler monitoring of the procedure. Adrenaline was administered under ultrasound guidance directly into the vascular structure presumed to be the source of the bleeding. This technique can be considered an effective and minimally invasive approach for managing bleeding complications of ultrasound-guided pleural biopsy, even though larger studies are needed to validate efficacy and safety of this approach.