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Post-bronchoscopy pneumothorax — SCE Respiratory MCQ

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HardInterventional PulmonologyPost-bronchoscopy pneumothoraxSCE Respiratory

A 58-year-old man undergoes bronchoscopy for haemoptysis. Two hours later he develops pleuritic chest pain and SpO2 falls to 90% on air. Breath sounds are reduced on the right and CXR shows a right apical pneumothorax. What is the most likely underlying cause?

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Correct answer: A — Transbronchial biopsy-related pneumothorax

Pneumothorax is a recognised complication after transbronchial biopsy and fits the post-procedure pleuritic pain and reduced breath sounds. Lidocaine toxicity would cause neurological or cardiac features rather than unilateral absent breath sounds. PE is possible after procedures but the CXR finding explains the acute presentation.

Reference: BTS Bronchoscopy guidance; BTS Pleural Disease Guideline 2023