Korean J Leg Med.  2017 Aug;41(3):73-77. 10.7580/kjlm.2017.41.3.73.

Death after Bronchoscopic Biopsy of a Pulmonary Artery Aneurysm Mimicking Bronchial Polyp

• Park JH
• Lee YS
• Oh YH
• Oh SM
• Kim HG
• Na JY

• KMID: 2389517
• DOI: http://doi.org/10.7580/kjlm.2017.41.3.73

Abstract

Pulmonary artery aneurysms (PAAs) are rare, and massive hemoptysis can lead to death if appropriate diagnosis and treatment is not provided. PAAs can be of congenital, acquired, or idiopathic origin, and the clinical symptoms are various. Among all reported cases, one-third of the patients died due to rupture. Optimal treatment or guidelines for PAAs remain uncertain. Herein, we report autopsy findings from a woman with PAA. The patient was taking medication for tuberculosis. On bronchoscopy, a polypoid lesion was found, suspected to be an inflammatory polyp. Biopsy was performed and massive bleeding into the airway occurred. The bleeding could not be controlled by bronchoscopic suction, and cardiac arrest occurred 30 minutes after biopsy; the patient subsequently died. Autopsy revealed a round, calcified PAA in the bronchus of the right middle lobe; the end of the PAA was torn. Hypovolemic signs, including weak postmortem lividity and pallor of the skin and conjunctivae, were observed. Visual inspection and histopathological examination of the right lung revealed tuberculosis and congestion. Cases related PAA are not uncommon, but autopsy cases of death occurring after biopsy of PAA mimicking bronchial polyps are rarely reported.

Keyword

Pulmonary artery aneurysm; Tuberculosis; Biopsy; Bronchoscopy; Autopsy

MeSH Terms

Aneurysm*
Autopsy
Biopsy*
Bronchi
Bronchoscopy
Conjunctiva
Diagnosis
Estrogens, Conjugated (USP)
Female
Heart Arrest
Hemoptysis
Hemorrhage
Humans
Hypovolemia
Lung
Pallor
Polyps*
Pulmonary Artery*
Rupture
Skin
Suction
Tuberculosis
Estrogens, Conjugated (USP)

Figure

• 

  Fig. 1 (A) On a cut section of the right lung, the parenchyma shows a chessboard like appearance. (B, C) A round, thick, polypoid lesion in the bronchus of the right middle lobe was identified, and the end of the lesion was torn. On a section of the bronchus, an aneurysm was found originating from the main pulmonary artery. (D) On histopathological examination, the wall of the aneurysm reveals calcification and the perivascular tissue showed multifocal necrosis and chronic inflammation with multinucleated giant cells (H&E, ×40).

• 

  Fig. 2 (A, B)The heart showed evidence of a previous Bentall operation with valve graft.

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