A 67-year-old female patient, complaining a history of poorly responsive bronchitic episodes and atrial fibrillation, underwent radiological work up after detection on January 2018 of a suspicious right upper lobe pulmonary lesion at chest X-ray. CT scan confirmed a right S1 irregular solitary nodule with signs of both mediastinal and parietal pleura involvement with concomitant multiple bilateral lymphadenopaties (stations 3, 4, 5) (February 2018). According to findings, an EBUS-TBNA bronchoscopy was performed on March 2018. The immediate postoperative period was uneventful as no intraoperative injuries, such as vascular or parenchymal ones, were reported. The hospital stay was uneventful and the patient was discharged on POD1. Twenty-four hours later, she was admitted to the Emergency Room Department due to the onset of relapsing episodes of haemoptysis. At admission, no impelling signs of cardiovascular impairment were reported (BP: 145/80 mmHg, HR: 88 beats per minute, T: 36.5  C, SaO2: 95%), as far as neither laboratory nor radiology highlighted any suggestive element for post-procedural complication.
At a rapid worsening of patient's clinical conditions requiring emergent oro-tracheal intubation, an urgent fibro-bronchoscopic evaluation showed the presence of an obstructive and non-viable subglottic formation with unsuccessful attempts of disobstruction till the onset of an irreversible cardio-circulatory arrest (Figure 1) due to acute respiratory distress and airway engorgement asphyxia. On autopsy, both lungs presented evident bloody polygonal areas alternating with compensatory emphysema ones. After en-bloc sampling of the airways, esophagus and heart, the section of the tracheal pars membranacea highlighted the presence of a blood clot that extended from the middle third of the tracheal lumen to the terminal bronchioles of both lungs (Figures 2,3).
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committees and with the Helsinki Declaration (as revised in 2013). No written informed consent has been obtained as anonymous data have been reported.