Pulmonary Hemorrhage and Air Embolism Complicating Transbronchial Biopsy in Pulmonary Amyloidosis

Strange, Charlie; Heffner, John E.; Collins, Bradford S.; Brown, Francis M.; Sahn, Steven A.

doi:10.1378/chest.92.2.367

Cited by 59 publications

(39 citation statements)

References 11 publications

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“…11,13 In terms of complications, bronchoscopy-guided transbronchial biopsy is a relatively unaggressive technique (pneumothorax occurring in 2 to 9% and haemorrhage in 1 to 6% of cases. [2][3][4] ), while surgical biopsy involves a substantial risk of causing serious iatrogenic complications. [6][7][8] Regarding complications, TBCB is in an intermediate position, with an overall complications rate of 16% in our series.…”

Section: Discussionmentioning

confidence: 99%

“…Bronchoscopy-guided transbronchial biopsy is associated with a low rate of iatrogenic complications, [2][3][4] but the usefulness of this technique is limited given its low diagnostic yield. 5 Surgical biopsy, on the other hand, provides high-quality samples but may lead to serious complications such as bronchopleural fistulae, severe worsening of existing lung disease and even death.…”

Section: Introductionmentioning

confidence: 99%

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Usefulness of an angioplasty balloon as selective bronchial blockade device after transbronchial cryobiopsy

et al. 2016

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Background and objective: Transbronchial cryobiopsy (TBCB) is a technique in which frozen samples of lung are obtained using a probe inserted through a bronchoscope. We performed a retrospective study to assess the performance of the TBCB procedure complemented by segmental bronchial blockade using an angioplasty balloon, in terms of diagnostic yield and safety in diffuse parenchymal lung disease (DPLD). Methods: Data from 100 patients with suspected DPLD (clinical and radiological findings), who underwent TBCB in our institution to establish a definitive diagnosis, were reviewed. In our institution, TBCB is monitored with fluoroscopy and performed under general anaesthesia by a multidisciplinary team (an anaesthesiologist, a pulmonologist and an interventional radiologist). In each patient, four samples were collected using a 2.4-mm distal diameter cryoprobe. To control bleeding, the biopsied segmental bronchus was blocked with a 6-mm diameter angioplasty balloon, inserted over a 0.035-inch angled hydrophilic guidewire. After the cryoextraction, the balloon was inflated for 3 min intervals until bleeding stopped. Results: Overall, 98% of samples had diagnostic value. In 85% of cases, DPLD was confirmed, while in 7%, cancer was diagnosed. Complications were observed in 16% of the patients: 13 patients developed moderate haemorrhage, and 3 developed pneumothorax. Conclusion: Transbronchial cryobiopsy had a high diagnostic yield for DPLD. Performing the procedure under fluoroscopy guidance and using angioplasty balloon for selective bronchial blockade achieved a low rate of iatrogenic complications directly associated with the technique.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Usefulness of an angioplasty balloon as selective bronchial blockade device after transbronchial cryobiopsy

et al. 2016

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“…Severe bleeding and pneumothorax are the most feared sideeffects of conventional transbronchial biopsies, and have been reported to occur in approximately 1-6 % and 2-9 %, respectively [37][38][39]. Bleeding is the main factor preventing larger or more numerous biopsy samples being obtained.…”

Section: Risksmentioning

confidence: 99%

Utilización de criosondas para la realización de la biopsia pulmonar transbronquial

Pajares

Torrego

Puzo

et al. 2010

Archivos de Bronconeumología

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AGRADECIMIENTOSSon muchos los momentos vividos en el hospital, tantos que puedo decir que Sant Pau se ha convertido en mi segunda casa. En mayo de 2004, comenzaba mi residencia y con ella, un viaje en el que he ido conociendo a muchos amigos y compañeros. Sus inestimables consejos me han hecho crecer como persona y como médico. Esta tesis tiene un poco de cada uno de ellos y por eso, quiero agradecerles su ayuda:A mis directores de tesis; el Dr. Joaquín Sanchis y el Dr. Vicente Plaza.Gracias Ximo, por orientarme desde el principio y por transmitirme la calidad y el rigor científico necesario para llevar a cabo todo este proceso. Gracias Vicente, por tu confianza y tus consejos. Y gracias por permitirme formar parte del gran equipo de profesionales de nuestro servicio.A mis dos maestros: Carmen Puzo y Alfons Torrego. Parece que fue ayer cuando llegué a broncoscopia como becaria. Es imposible resumir todo lo que he aprendido de vosotros. Carmen, gracias por descubrirme el "arte" de la broncoscopia y por enseñarme a "pasear por los bronquios". Decir que he aprendido de ti, Dra. Puzo, es un orgullo y sinónimo de excelencia por dónde vaya.Gracias por compartir tus conocimientos y tu experiencia. Alfons, imposible pensar que esta tesis se hubiera podido escribir sin ti. Has sido mi mentor. La persona que confió en mí para llevar a cabo este proyecto y quién me animó a seguir a pesar de las múltiples dificultades. Es increíble tu capacidad de trabajo y la generosidad e ilusión con la que transmites tus conocimientos. Gracias.

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“…laryngotracheal or bronchial spasm, massive hemoptysis, arrhythmia, airway obstruction, pneumothorax, esophagotracheal fistula, tracheal perforation, or death). Cerebral air embolism following bronchoscopy or CT-guided biopsy has been only anecdotally reported in the literature and to the best of our knowledge has not been systematically reported in larger trials [6,7] . The paucity of such reports might reflect the rarity of this severe adverse event or underdiagnosis or underreporting, respectively.…”

Section: Introductionmentioning

confidence: 96%

Fatal Cerebral Air Embolism following Uneventful Flexible Bronchoscopy

et al. 2010

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needle aspiration and transbronchial biopsy, resulting in a frequency of ! 0.02% for this severe complication in our institution. In addition to early supportive measures, 1 patient received hyperbaric oxygen therapy as further treatment. Prompt recognition of this complication is mandatory in order to implement appropriate supportive measures. Highflow oxygen should be administered and hyperbaric oxygen therapy may be considered, if available. If possible, positive pressure ventilation should be avoided. AbstractFlexible bronchoscopy is a widely used and safe procedure with a reported maximal mortality rate of 0.04% and a majorcomplications rate of 0.5%. There are, however, only few case descriptions for postinterventional cerebral air embolism and the frequency of this supposedly rare complication is unknown. The current study presents 2 patients with nonsmall cell lung cancer who suffered fatal cerebral air embolism following diagnostic bronchoscopy with transbronchial Established Facts• Flexible bronchoscopy is a frequently used and safe procedure with reported rates of mortality, major complications, and minor complications of 0.1, 1.7, and 6.5%, respectively. • Cerebral embolism following transbronchial needle aspiration and/or transbronchial biopsy is an exceedingly rare complication of unknown frequency. Novel Insights• We herein report 2 cases of seemingly uneventful bronchoscopies that resulted in fatal cerebral air embolism.• Although this complication occurred with a frequency of ! 0.02% in our institution, every bronchoscopist should recognize this severe adverse event in order to initiate prompt supportive measures and consider hyperbaric oxygen therapy.

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Pulmonary Hemorrhage and Air Embolism Complicating Transbronchial Biopsy in Pulmonary Amyloidosis

Cited by 59 publications

References 11 publications

Usefulness of an angioplasty balloon as selective bronchial blockade device after transbronchial cryobiopsy

Usefulness of an angioplasty balloon as selective bronchial blockade device after transbronchial cryobiopsy

Utilización de criosondas para la realización de la biopsia pulmonar transbronquial

Fatal Cerebral Air Embolism following Uneventful Flexible Bronchoscopy

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