Yang CL, Zhou R, Jin ZX, Chen M, Zi BL, Li P, Zhou KH. Atrial fibrillation and concomitant left subclavian, axillary and brachial artery embolism after fiberoptic bronchoscopy: A case report. World J Clin Cases 2021; 9(33): 10233-10237 [PMID: 34904093 DOI: 10.12998/wjcc.v9.i33.10233]
Corresponding Author of This Article
Kai-Hua Zhou, MM, Chief Physician, Department of Respiratory, Kunming Municipal First People's Hospital, No. 1288 Beijing Road, Kunming 650000, Yunnan Province, China. zkh51033528@sina.com
Research Domain of This Article
Respiratory System
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Nov 26, 2021; 9(33): 10233-10237 Published online Nov 26, 2021. doi: 10.12998/wjcc.v9.i33.10233
Atrial fibrillation and concomitant left subclavian, axillary and brachial artery embolism after fiberoptic bronchoscopy: A case report
Cui-Lin Yang, Ran Zhou, Zhi-Xian Jin, Min Chen, Bao-Li Zi, Ping Li, Kai-Hua Zhou
Cui-Lin Yang, Zhi-Xian Jin, Min Chen, Bao-Li Zi, Ping Li, Kai-Hua Zhou, Department of Respiratory, Kunming Municipal First People's Hospital, Kunming 650000, Yunnan Province, China
Ran Zhou, Department of Respiratory, The First People's Hospital of Yunnan Province, Kunming 650000, Yunnan Province, China
Author contributions: Chen M and Jin ZX were the attending physicians for the patient, reviewed the literature, and contributed to writing the manuscript; Zi BL and Li P reviewed the literature and contributed to writing the manuscript; Zhou KH performed the bronchoscopy procedure and contributed to manuscript writing; Zhou R was responsible for revising the manuscript for important intellectual content; all authors approved the final submitted version of the manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kai-Hua Zhou, MM, Chief Physician, Department of Respiratory, Kunming Municipal First People's Hospital, No. 1288 Beijing Road, Kunming 650000, Yunnan Province, China. zkh51033528@sina.com
Received: November 13, 2020 Peer-review started: November 13, 2020 First decision: July 8, 2021 Revised: August 4, 2021 Accepted: September 13, 2021 Article in press: September 13, 2021 Published online: November 26, 2021
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.
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.
