Post interventional local bleeding within the mediastinal lymph nodes - A rare complication during EBUS procedure

According to the Aquire registry EBUS is a safe and efficient procedure established in pulmonary medicine. Complications during EBUS procedure are rare and not associated with death. We describe an unexpected incident in our unit; a center that preforms this procedure over 200 times a year. EBUS was preformed in a 36 year old male patient with mediastinal lymphadenopathy under topical anesthesia and conscious sedation. The lymph node position 4, 10 and 7 were aspirated with a 22 GA needle system for pathological verification of sarcioidosis. One hour after the procedure the patient suffered of severe chest pain localized behind his sternum. Myocardial infarction was excluded although CK and LDH levels were elevated. The ct scan of the thorax showed in lymphnode position 7 left a consecutive swelling double sized the former status (-6cm) due to a local bleeding. A thoracotomy was considered but under monitoring conditions and supplement of pain reliever the thoracal symptoms vanished. The ct scan documented within the intervall of 16 hours a complete reduction of the local swelling of the lymph node to the size before the intervention. No further problems were reported and the patient was dismissed. Local bleeding in a punctured lymph node region during EBUS procedure without receiving antiplatlet therapy is a rare complication with a spontaneous reconvalescence within 16 hours. Intensive monitoring should be considered.