Anatomically remote endobronchial haemorrhage after EBUS-TBNA

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive, widely used diagnostic procedure for mediastinal and central lung lesions. Although rare, complications such as bleeding, pneumothorax and infection have been reported. Typically, airway bleeding, when it occurs, is attributed to vascular injury at the needle puncture site or oozing from the lesion itself through the needle tract. We report an unusual case of endobronchial haemorrhage during EBUS-TBNA of a right hilar mass, in which bleeding emerged from a bronchial segment anatomically distant from the needle puncture site. The EBUS-TBNA needle entry point was through the posterior wall of mid-trachea under real-time ultrasound and Colour Doppler guidance to avoid vascular structures. Despite these precautions, active bleeding was observed originating from the posterior segment of the right upper lobe bronchus. This was suggestive of possible intralesional haemorrhage with communication to a distant airway, leading to active bleed from a non-target site. The complication was promptly identified and managed effectively, avoiding any further escalation. To the best of our knowledge, this is the first reported case of anatomically remote endobronchial bleeding during EBUS-TBNA. It underscores the importance of robust emergency protocols for managing unexpected and potentially serious complications.