Hypertrophied bronchial artery as a cause of bleeding after transbronchial needle aspiration.

which the bleeding originated was promptly performed [2] . We believe that a diagnosis of Dieulafoy’s disease would be unlikely in the patients of the present series as there were no endobronchial abnormalities at the puncture site, there was no evidence of submucosal extension of the artery at the CT reconstruction, and the bleeding was at most moderate and self-resolving. Major bleeding after conventional transbronchial needle aspiration (TBNA) has always been associated with inadvertent puncture of large mediastinal vessels, especially of the aorta. However, it is possible to observe unexpectedly conspicuous endobronchial bleeding after TBNA even when the procedure is performed in areas that do not usually contain large vessels (e.g. the subcarinal area). In the last 3 years, we did observe 5 cases of remarkable, yet self-resolving, endobronchial bleeding caused by TBNA of mediastinal lymph nodes. Careful review of the CT scan showed, in any such patient, the presence of a large bronchial artery crossing the mediastinum at the level of the sampled lymph node ( fig. 1–3 ). Hypertrophied bronchial arteries, which are a prominent cause of severe hemoptysis, are most commonly seen in patients with bronchiectasis, pulmonary tuberculosis, pulmonary thromboembolism, or chronic obstructive pulmonary disease [1] . Their major locations are the retrotracheal area, retroesophageal area, posterior wall of the main bronchus and aortopulmonary window [1] . The main differential diagnosis in each patient of our series would be Dieulafoy’s disease, a condition characterized by the presence of a dysplasic artery in the respiratory submucosa [2] . The rupture of this large artery, sometimes iatrogenic [2] , is usually associated with massive hemoptysis that almost invariably lead to the patient’s death unless the surgical removal of the lobe from Published online: August 11, 2011