Atrial fibrillation and concomitant left subclavian, axillary and brachial artery embolism after fiberoptic bronchoscopy: A case report

Abstract

BACKGROUND

Fiberoptic bronchoscopy has been widely used in the diagnosis and treatment of respiratory diseases. Numerous major and minor complications have been reported following this procedure. The incidence of major postoperative complications is approximately 0.5% and includes respiratory depression, pneumothorax, pulmonary edema, pneumonia, airway obstruction and cardiorespiratory arrest. Minor complications include vasovagal reactions, cardiac arrhythmias, hemorrhage, pneumothorax, aphonia, nausea, vomiting and fever. However, to our knowledge, a case of atrial fibrillation (AF) concomitant with fatal arterial embolism in the upper extremities following diagnostic bronchoscopy has never been reported.

CASE SUMMARY

A 70-year-old female patient presented with a history of rheumatic heart disease beginning at 10 years of age and an approximately 10-year history of hypertension. The patient was transferred from the cardiology department to the respiratory department due to recurrent coughing, pneumonia, and fever. She underwent fiberoptic bronchoscopy in the respiratory department. Approximately 2 h after completion of bronchoscopy, she complained of left arm numbness and weakness. Physical examination detected cyanosis of the left upper extremity, grade III weakened limb muscle strength, and undetectable left brachial artery pulsation. Auscultation indicated AF. B-mode ultrasound examination of the blood vessels showed hyperechoic material in the left subclavian, axillary and brachial arteries, and parallel veins. As our hospital has no vascular surgery capability, the patient was transferred to a specialized hospital for emergency thrombectomy that day. A tracking investigation found that the patient’s conditions improved after successful thrombectomy.

CONCLUSION

Thromboembolism following bronchoscopy is rare, and only a few cases of cerebral air embolism after bronchoscopy have been reported.

Keywords: Fiberoptic bronchoscopy; Complications; Atrial fibrillation; Thromboembolism; Anticoagulant therapy; Case report

Core Tip: This case highlights the fact that although fiberoptic bronchoscopy is generally a well-known and safe procedure, serious complications, such as arterial thrombosis may occur. The risk of developing arterial thrombosis following bronchoscopy is higher in patients with atrial fibrillation with mitral stenosis, highlighting the need for a rigorous risk assessment in these patients.