Severe coronary artery spasm associated with endobronchial cytologic sampling, bleeding, and endobronchial...

Although coronary artery spasms during bronchoscopies are rare, they can cause severe cardiac complications. An 84-year-old man receiving enzalutamide for prostate cancer underwent a bronchoscopy for the diagnostic evaluation of a 20-mm ground-glass nodule in the left S3 segment, detected on chest computed tomography. After endobronchial cytologic sampling using a curette, transient ST-segment elevation was observed on electrocardiography. Bleeding from the left B3 bronchus was controlled by local instillation of a few millilitres of 1:100,000 epinephrine. Shortly afterward, hypoxaemia, hypotension, bradycardia, and recurrent ST-segment elevation developed. Echocardiography revealed inferior and right ventricular wall hypokinesis, whereas coronary angiography revealed no significant stenosis, confirming a coronary artery spasm. The patient recovered with conservative treatment. This case indicates that coronary artery spasms associated with endobronchial cytologic sampling, bleeding, or local epinephrine use may occur during bronchoscopy, and that ST-segment elevation during the procedure may serve as an early indicator of coronary spasm requiring prompt action.