INTRODUCTION: Transbronchial biopsies are generally safe to perform with the most frequent complications being pneumothorax and pulmonary hemorrhage (1). Other rare complications include empyema, respiratory failure and death. We report a case of a visceral pleural hematoma presenting as a pleural mass following transbronchial biopsy in a patient with systemic amyloidosis.
CASE PRESENTATION: A 66 year-old with a history of amyloidosis presented to the hospital with pneumonia for which bronchoscopy and transbronchial biopsy were eventually performed. During follow-up, he was noted to have an enlarging pleural effusion associated with a pleural-based mass. CT demonstrated an enlarging mass projecting off of the visceral pleura and bedside ultrasound confirmed the presence of a homogenous, septated lesion. Two thoracenteses revealed an exudative pleural effusion without malignancy or infection. A VATS biopsy of the pleura accompanied by removal of the pleural-based mass was performed and confirmed the presence of a visceral pleural hematoma. Given that this was absent immediately prior to transbronchial biopsy and appeared thereafter, the visceral pleural hematoma was felt secondary to the transbronchial biopsy.
DISCUSSIONS: Transbronchial biopsies may have complications in the parenchyma (hemorrhage) or pleura (pneumothorax). Thoracic hematomas, on the other hand, typically develop from trauma, although spontaneous occurrences and hematomas associated with surgery, pneumothorax, and tuberculosis have been described (2). Amyloidosis is associated with fragile blood vessels that result from amyloid deposition in the walls of the vessels and is also associated with bleeding problems, including bleeding after procedures. In this case, transbronchial biopsy in a patient with pulmonary amyloidosis led to the development of a visceral pleural hematoma. It was expanding slowly, presumptively similar to reported cases of chronic expanding hematoma of the thorax.
CONCLUSION: Transbronchial biopsies may be associated with bleeding and pleural complications, typically pneumothorax. In this case, transbronchial biopsy in a patient with pulmonary amyloidosis led to the development of a visceral pleural hematoma presenting as a pleural-based mass. A history of prior transbronchial biopsy should be ascertained in the evaluation of patients with solitary pleural tumors.
DISCLOSURE: Jonathan Puchalski, No Financial Disclosure Information; No Product/Research Disclosure Information