CTICasesIatrogenic Bronchial Artery Hemorrhage Post-Lymph Node Biopsy
Imaging findings
Serial chest radiographs obtained twelve days apart, before and after a bronchoscopy, demonstrate progressive horizontalization and narrowing of the left main bronchus. A non-contrast chest CT reveals a high-attenuation subcarinal mass consistent with a hematoma. Subsequent contrast-enhanced CT confirms a large subcarinal hematoma causing marked mass effect on the left main bronchus, with a focus of active contrast extravasation arising from a bronchial artery branch.
Key takeaways
Subcarinal lymph node biopsy via bronchoscopy can be complicated by iatrogenic vascular injury, particularly hemorrhage from adjacent bronchial artery branches. The resulting subcarinal hematoma can rapidly enlarge, causing compression and narrowing of the left main bronchus, which can be suspected retrospectively on chest radiographs. Prompt contrast-enhanced CT is essential to identify active extravasation, which may require endovascular embolization, although iatrogenic dissection or spasm of the feeding bronchial artery during angiography can occasionally result in spontaneous stasis and resolution.
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