SESSION TITLE: Uncommon Procedures and Procedure Complications Case PostersSESSION TYPE: Case Report PostersPRESENTED ON: 10/17/2022 12:15 pm - 01:15 pmINTRODUCTION: Life-threatening hemoptysis is an exceedingly rare complication following endobronchial ultrasound guided transbronchial fine needle aspiration (EBUS-TBNA). Here, we present a case of massive hemoptysis that occurred three days after EBUS-TBNA in a 55-year-old male with end-stage renal disease (ESRD).CASE PRESENTATION: 55-year-old male with past medical history of ESRD on intermittent dialysis presented with shortness of breath. CT chest without contrast showed extensive mediastinal lymphadenopathy concerning for infection or malignancy. The patient was continued on home medication aspirin 81 mg and DVT prophylaxis with subcutaneous heparin 5,000U TID. INR, PT and PTT were within normal limits. Patient underwent EBUS-TBNA of largest lymph node found at station seven and eight passes were performed with Boston Scientific Acquire Needle 22G needle. Post-procedural course was complicated by bleeding at biopsy site and subsequent blood clot formation which was successfully resected with flexible cryoprobe. Three days later, he developed significant hemoptysis totaling approximately 800 cc. Bedside bronchoscopy showed pulsatile bleeding at puncture site. Balloon blocker was successfully inflated in the bronchus intermedius to tamponade bleeding. Patient remained intubated and repeat bronchoscopy 48 hours later showed residual clot in the distal bronchus intermedius and basal subsegmental takeoffs which were removed with flexible cryoprobe. Twelve hours post-bronchoscopy bleeding recurred requiring bronchial arterial embolization performed by interventional radiology.DISCUSSION: The overall complication rate for EBUS-TBNA is less than two percent with the most common complication being hypoxia and increased level of care. Bleeding complications requiring intervention account for approximately .2% of overall cases. Current guidelines recommend continuation of low dose aspirin prior to EBUS-TBNA. In our patient, the combination of antiplatelet therapy and underlying platelet dysfunction from ESRD may have contributed to life-threatening hemoptysis. Furthermore, delayed onset of hemoptysis after EBUS-TBNA is rarely reported in the literature. It is difficult to identify patients at risk for severe bleeding and these patients may require advanced interventions including bronchial arterial embolization.CONCLUSIONS: Life-threatening hemoptysis is extremely rare following EBUS-TBNA. Current guidelines recommend continuation of low dose aspirin pre-procedure. However, further studies are needed to identify patients with risk factors for significant bleeding which may include ESRD.Reference #1: Youness HA, Keddissi J, Berim I, Awab A. Management of oral antiplatelet agents and anticoagulation therapy before bronchoscopy. J Thorac Dis. 2017;9(Suppl 10):S1022-S1033. doi:10.21037/jtd.2017.05.45Reference #2: Sabath BF. Delayed massive hemoptysis after endobronchial ultrasound-guided transbronchial needle aspiration. Endosc Ultrasound. 2020;9(6):419-420. doi:10.4103/eus.eus_50_20Reference #3: Eapen GA, Shah AM, Lei X, Jimenez CA, Morice RC, Yarmus L, Filner J, Ray C, Michaud G, Greenhill SR, Sarkiss M, Casal R, Rice D, Ost DE; American College of Chest Physicians Quality Improvement Registry, Education, and Evaluation (AQuIRE) Participants. Complications, consequences, and practice patterns of endobronchial ultrasound-guided transbronchial needle aspiration: Results of the AQuIRE registry. Chest. 2013 Apr;143(4):1044-1053. doi: 10.1378/chest.12-0350. PMID: 23117878; PMCID: PMC3616680.DISCLOSURES: No relevant relationships by Mouhanned EliliwiNo relevant relationships by Michelle MilesNo relevant relationships by Keenan Taylor SESSION TITLE: Uncommon Procedures and Procedure Complications Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Life-threatening hemoptysis is an exceedingly rare complication following endobronchial ultrasound guided transbronchial fine needle aspiration (EBUS-TBNA). Here, we present a case of massive hemoptysis that occurred three days after EBUS-TBNA in a 55-year-old male with end-stage renal disease (ESRD). CASE PRESENTATION: 55-year-old male with past medical history of ESRD on intermittent dialysis presented with shortness of breath. CT chest without contrast showed extensive mediastinal lymphadenopathy concerning for infection or malignancy. The patient was continued on home medication aspirin 81 mg and DVT prophylaxis with subcutaneous heparin 5,000U TID. INR, PT and PTT were within normal limits. Patient underwent EBUS-TBNA of largest lymph node found at station seven and eight passes were performed with Boston Scientific Acquire Needle 22G needle. Post-procedural course was complicated by bleeding at biopsy site and subsequent blood clot formation which was successfully resected with flexible cryoprobe. Three days later, he developed significant hemoptysis totaling approximately 800 cc. Bedside bronchoscopy showed pulsatile bleeding at puncture site. Balloon blocker was successfully inflated in the bronchus intermedius to tamponade bleeding. Patient remained intubated and repeat bronchoscopy 48 hours later showed residual clot in the distal bronchus intermedius and basal subsegmental takeoffs which were removed with flexible cryoprobe. Twelve hours post-bronchoscopy bleeding recurred requiring bronchial arterial embolization performed by interventional radiology. DISCUSSION: The overall complication rate for EBUS-TBNA is less than two percent with the most common complication being hypoxia and increased level of care. Bleeding complications requiring intervention account for approximately .2% of overall cases. Current guidelines recommend continuation of low dose aspirin prior to EBUS-TBNA. In our patient, the combination of antiplatelet therapy and underlying platelet dysfunction from ESRD may have contributed to life-threatening hemoptysis. Furthermore, delayed onset of hemoptysis after EBUS-TBNA is rarely reported in the literature. It is difficult to identify patients at risk for severe bleeding and these patients may require advanced interventions including bronchial arterial embolization. CONCLUSIONS: Life-threatening hemoptysis is extremely rare following EBUS-TBNA. Current guidelines recommend continuation of low dose aspirin pre-procedure. However, further studies are needed to identify patients with risk factors for significant bleeding which may include ESRD. Reference #1: Youness HA, Keddissi J, Berim I, Awab A. Management of oral antiplatelet agents and anticoagulation therapy before bronchoscopy. J Thorac Dis. 2017;9(Suppl 10):S1022-S1033. doi:10.21037/jtd.2017.05.45 Reference #2: Sabath BF. Delayed massive hemoptysis after endobronchial ultrasound-guided transbronchial needle aspiration. Endosc Ultrasound. 2020;9(6):419-420. doi:10.4103/eus.eus_50_20 Reference #3: Eapen GA, Shah AM, Lei X, Jimenez CA, Morice RC, Yarmus L, Filner J, Ray C, Michaud G, Greenhill SR, Sarkiss M, Casal R, Rice D, Ost DE; American College of Chest Physicians Quality Improvement Registry, Education, and Evaluation (AQuIRE) Participants. Complications, consequences, and practice patterns of endobronchial ultrasound-guided transbronchial needle aspiration: Results of the AQuIRE registry. Chest. 2013 Apr;143(4):1044-1053. doi: 10.1378/chest.12-0350. PMID: 23117878; PMCID: PMC3616680. DISCLOSURES: No relevant relationships by Mouhanned Eliliwi No relevant relationships by Michelle Miles No relevant relationships by Keenan Taylor