Thes source code shows that the "alt text" is actually in the very bottom of the Document tree.
https://media.mementomori.social/media_attachments/files/111/199/915/727/675/876/original/dcd6088a3bbe6ae6.png
Just noticed Bluesky doesn't ACTUALLY add the alt text in the img itself. This is a big mistake and makes the service very inaccessible.
The text is actually in the very last part of the DOM (Document Object Model) tree... and is triggered via click. So, if the screen reader doesn't support JavaScript, descriptive text is nowhere to be found. Even when it is, it can't be accessed easily.
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