Near-fatal hemorrhage after bronchoscopic resection of a carcinoid tumor: successful management by bronchial artery embolization.

A 36-year-old man presented with a large tracheal carcinoid just above the carina. The size and location precluded surgical treatment and so he underwent bronchoscopic tumor resection using electrocautery. After approximately 80% of tumor removal, brisk hemorrhage from the tumor stalk necessitated endotracheal intubation with anatomic lung separation and use of high cuff pressure to tamponade the bleeding site. This emergency measure was life saving, but extubation was not possible because of recurrence of bleeding whenever the tamponading cuff was deflated. Forty-eight hours later bronchial artery angiogram was performed to localize the bleeding site, and the vessels were successfully embolized using a gel foam. Cessation of bleeding facilitated successful extubation of the patient.