Pulmonologist Punctures Large Blood Vessel During Lung Biopsy

Case Overview

This case involves a fifty-nine-year-old male patient who presented to the hospital with complaints of chest pain, shortness of breath, and a persistent cough. The patient had been a chronic smoker but had quit due to respiratory trouble. A suspicious spot on the chest imaging along with the presenting symptoms prompted physicians to order a lung biopsy. A CT-guided biopsy was performed using a posterior approach and there were no immediate complications in the PACU. Three core samples were taken and the pathologist provided a pathology report that diagnosed a poorly differentiated squamous cell carcinoma. Shortly after the procedure, the patient developed shortness of breath and a severely increased heart rate. He was transferred to ICU and immediately upon arrival, he went into cardiopulmonary arrest. ACLS maneuvers were initiated while a chest tube was placed that returned 3000cc of dark red blood. Three units of emergency blood were administered during the code, but the patient died soon thereafter.

Questions to the Critical Care Medicine expert and their responses

What are the accepted complications of this procedure?

Complications are rare with transthoracic needle biopsy, as long as pneumothorax is considered to be an accepted part of the procedure. Pneumothorax only occurs in 20-33% of patients undergoing TNB; this rate is interesting given that a needle is purposefully passed into the lung. A hemothorax or bleeding is not an accepted complication as all major vessels should be clearly avoided especially when conducting the procedure via CT guidance. Some serious bleeding, however, may occur in about 1% of all thoracocentesis procedures.

Should the bleeding have been noticed before the patient was sent back to the recovery area?

If bleeding does occur, it should be addressed immediately, as this is considered to be a medical emergency.

About the expert

This extremely qualified, board certified and fellowship trianed pulmonologist currently holds clinical, academic, and research positions at among the finest medical institutions in the nation. He is extensively published in his field, and has given numerous invited lectures nationwide. He also holds a medical patent. These strong qualifications make him highly capable of reviewing the case at hand.