Bleeding Complications

The second major complication is hemorrhagic complications. Fortunately, these are minor and insignificant. The pulmonary vascular system is a low pressure system and the bleeding usually stops spontaneously.

It is important to warn the patient and reassure him. Both you and the attendants should be calm and reassuring. I like to keep an IV open and keep the patient on oxygen, anticipating this complication. Cold ice packs can cause reflex vasospasm and help control bleeding.

Occasionally, a major bleeding episode can occur. This complication can occur following a biopsy in patients with pulmonary hypertension and biopsy of hilar lesions, and in patients with bleeding diathesis. The tracheo-bronchial tree can be flooded with blood, eventuating to respiratory failure and death.

There is very little one can do when this complication occurs. Intubate the patient and selectively ventilate a good lung. One can attempt to pass a fogarty catheter to an involved segment and inflate the balloon with the aim of containing the bleeding. The patient would require emergency surgery. Induction of pneumothorax has been suggested to stop perfusion to that side. Unfortunately, this is usually a fatal complication.

Take every precaution to avoid this by following these three suggestions:

  1. Avoid trucut biopsy except for mass lesions adherent to the chest wall.

  2. Avoid the procedure in patients with severe pulmonary hypertension.

  3. Cavitating lesions tend to bleed more and attempt only an aspiration biopsy.