CTICasesPost-Bronchoscopy Hemorrhage with Bronchial Obstruction and Lobar Collapse
Imaging findings
A patient who underwent bronchoscopy with biopsy of calcified hilar lymph nodes (thought to reflect old granulomatous disease) developed hemoptysis and worsening dyspnea a couple of days later. Radiograph showed combined right middle and right lower lobe collapse (loss of the diaphragm and right heart border, absent minor fissure) plus a subtle left upper lobe opacity, and CT confirmed left upper lobe collapse from a clot in the bronchus along with abrupt occlusion of the bronchus intermedius by clot causing right middle and right lower lobe collapse.
Key takeaways
Post-bronchoscopy hemorrhage can produce clot that plugs the bronchus intermedius and a segmental bronchus, causing multilobar collapse that can be mistaken for a primary airway or parenchymal process if the procedural history is not considered; recognizing the abrupt, complete airway cutoff by endobronchial clot on CT following a recent biopsy is key to correctly attributing the collapse to bleeding rather than tumor or mucus plugging alone.
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