Laceration of left pulmonary artery during mediastinoscopy

During a mediastinoscopy on a 65-year-old man with a carcinoma of the lung, the left pulmonary artery was biopsied inadvertently. The patient became hypotensive due to a loss of 1500 ml of blood in less than 5 minutes. Rapid administration of plasma and whole blood and emergency thoracotomy to control bleeding were necessary. The authors suggest securing an IV route using a large-bore catheter and stress the need to be alert to the possibility of life-threatening hemorrhage occurring during mediastinoscopy.