Hong Ping-Yang, Huang Mao-Hong, Cai Ling, Chen Yi-Yuan, Guo Yu-Xin, Zhang Xiao-Bin
Department of Pulmonary and Critical Care Medicine, School of Medicine, Zhongshan Hospital of Xiamen University, Xiamen University, Xiamen, Fujian, China.
The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, China.
BMC Pulm Med. 2025 Jan 25;25(1):42. doi: 10.1186/s12890-025-03503-5.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is commonly used for diagnosing mediastinal lymphadenopathy. Despite a low complication rate, severe hemorrhage can occur which is reported in this literature, particularly in hypervascular conditions like Castleman disease.
A 54-year-old male with idiopathic multicentric Castleman disease underwent EBUS-TBNA for mediastinal lymph node sampling. During the procedure, vascular invasion led to significant bleeding, requiring immediate interventions including suctioning and therapeutic bronchoscopy.
The patient experienced massive hemorrhage, resulting in airway obstruction, oxygen desaturation, and cardiac arrest. Aggressive resuscitation successfully restored cardiac rhythm after 15 min. The patient was then stabilized and transferred to the intensive care unit for monitoring.
This case underscores the risk of severe hemorrhage in hypervascular conditions during EBUS-TBNA. Pre-procedural imaging, careful planning, and immediate availability of hemostatic measures are crucial to reducing complications and improving outcomes in high-risk patients.
支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）常用于诊断纵隔淋巴结肿大。尽管并发症发生率较低，但严重出血仍可能发生，本文献中有相关报道，尤其是在诸如Castleman病等血管丰富的情况下。
一名患有特发性多中心Castleman病的54岁男性接受了EBUS-TBNA以获取纵隔淋巴结样本。在操作过程中，血管侵犯导致大量出血，需要立即采取包括抽吸和治疗性支气管镜检查在内的干预措施。
患者出现大量出血，导致气道阻塞、氧饱和度下降和心脏骤停。积极复苏在15分钟后成功恢复心律。然后患者病情稳定并转入重症监护病房进行监测。
该病例强调了EBUS-TBNA在血管丰富情况下发生严重出血的风险。术前影像学检查、精心规划以及止血措施的即时可用对于降低高危患者的并发症和改善预后至关重要。
