A pulsatile endobronchial lesion: A vascular mimic of airway pathology

We describe the case of a 68-year-old woman who presented with intermittent haemoptysis and a significant family history of lung cancer. A non-contrast CT thorax was unremarkable aside from minor right lower lobe scarring. Flexible bronchoscopy demonstrated a pulsatile endobronchial lesion within the posterior basal segment of the right lower lobe bronchus. Given its pulsatile appearance, biopsy was deferred because of concern for an underlying vascular lesion. Bronchoalveolar lavage was negative for malignancy and infection. Subsequent rigid bronchoscopy confirmed the lesion, with no evidence of mucosal disruption or active bleeding. CT pulmonary angiography, performed only after the bronchoscopic findings, demonstrated a focal pulmonary arterial vascular anomaly. A vascular loop arising from a segmental right lower lobe pulmonary artery corresponded to the bronchoscopic abnormality. There was no evidence of aneurysm, arteriovenous malformation, or pulmonary embolism. In view of the reassuring imaging findings and the patient's clinical stability, a conservative management approach was adopted. She remained symptom-free at six-month follow-up. This case highlights the importance of recognising potential vascular lesions during bronchoscopy to avoid catastrophic iatrogenic bleeding. Visible pulsatility should prompt immediate avoidance of biopsy and further evaluation with contrast-enhanced vascular imaging and endobronchial ultrasound.