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

Korean J Leg Med 2017;41:73-77

Forensic Medicine Division, National Forensic Service Gwangju Institute, Jangseong, Korea,

Biomedical Research Institute, Chonnam National University Hospital, Gwangju, Korea

pdrdream@gmail.com

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.

Key Words: Pulmonary artery aneurysm; Tuberculosis; Biopsy; Bronchoscopy; Autopsy