Delayed Massive Haemoptysis Following EBUS-TBNA Revealing a Pseudoaneurysm of an Ectopic Bronchial Artery: A Rare Complication at the Crossroads of Interventional Pulmonology and Radiology.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is widely considered a safe and minimally invasive procedure for the evaluation of mediastinal lymphadenopathy. Although complications are rare, severe haemorrhagic events may occur, particularly when vascular structures are punctured. A 31-year-old woman with Budd-Chiari syndrome underwent EBUS-TBNA for hypermetabolic mediastinal lymph nodes. Sampling was uneventful, but she developed massive haemoptysis 7 days later. Contrast-enhanced CT and bronchoscopy identified two 4R lymph node pseudoaneurysms, confirmed by angiography. The lesion was successfully treated with selective microcoil embolisation. No recurrence was observed at two-month follow-up, despite resuming anticoagulation. Delayed pseudoaneurysm is an exceptionally rare but potentially life-threatening complication of EBUS-TBNA. Pre-procedural Doppler assessment, awareness of vascular variants, and timely imaging are essential. Endovascular embolisation is an effective, minimally invasive treatment. Early recognition and multidisciplinary management are crucial to prevent catastrophic outcomes.