Bronchoscopy is a common and a safe procedure with low mortality and complications. The risk of pneumothorax (PTX) is estimated to be 0.1% but increases to (1-6%) with the addition of transbronchial lung biopsy (TBB) [1]. Studies have shown that a short observation is adequate after TBB and the usual practice is to perform a portable chest radiograph (CXR) to rule out PTX. Delayed PTX is a rare complication post TBB and few cases have been reported in the literature. We discuss a patient with delayed PTX 48 hours post TBB. CASE PRESENTATION: A 71 year old male with a history of malignancy of unknown primary with metastasis to the sacrum and vertebral column presented with lower limbs weakness status post palliative radiation to the spine and was noted to have a left upper lobe lung nodule on CT chest. He underwent bronchoscopy with TBB to determine if it was a primary malignancy of lung. He was stable post-procedure with an unremarkable portable CXR, and was discharged with outpatient follow up. Two days later, he presented to the emergency department with shortness of breath and hypoxemia. A CXR was performed which showed a left sided PTX. A chest tube was placed and a follow up CXR showed lung re-expansion. The chest tube was removed after two days and the patient was discharged home with a total of four days of hospitalization.
Bronchoscopy is a common and safe procedure with low mortality rates and complications. The risk of pneumothorax (PTX) post bronchoscopy is estimated to be 0.1% but increases to 1-6% with the addition of transbronchial lung biopsy (TBB) to the procedure. Studies have shown that a short observation period is adequate after TBB, and the usual practice is to perform a portable chest radiograph (CXR) to rule out PTX. Delayed PTX is a rare complication post-TBB and very few cases have been reported in the literature. In this report, we discuss a patient with delayed PTX 48 hours post-TBB.Delayed PTX is a rare complication post-TBB and should be considered in patients who are stable postprocedure but present with dyspnea and/or hypoxemia even days after the procedure.
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