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Spontaneous Pneumothorax After Partial Resolution of Total Bronchial Obstruction Following Chemoradiotherapy for Small Cell Carcinoma FREE TO VIEW

Praveen Jinnur*, MD; Viswanath Vasudevan, MD; Farhad Arjomand, MD; Rana Ali, MD; Tarkeshwar Tiwary, MD; Vijaykumar Vanam, MD; Abbas Qammar, MD
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The Brooklyn Hospital Center, Brooklyn, NY

Chest. 2012;142(4_MeetingAbstracts):595A. doi:10.1378/chest.1382028
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SESSION TYPE: Cancer Case Report Posters I

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Cancer-related pneumothorax is a rare complication of pneumothorax and most are reported in lung metastasis. It is very rarely seen in those with a primary lung carcinoma. We present a case of endobronchial small cell carcinoma of the lung with bronchial occlusion and lung atelectasis who developed pneumothorax following chemoradiation. She responded well to chest tube placement with complete lung expansion and spontaneous resolution of air leak.

CASE PRESENTATION: 53 year old lady with history of heavy cigarette smoking was admitted for evaluation of progressive weight loss, loss of appetite and dyspnea. Chest exam revealed absent breath sounds on the left side. CXR done on admission is as shown (Fig.1). Bronchoscopy revealed an endobronchial lesion with complete obstruction of left main bronchus. The tumor was located within 1.5 cm from the main carina. Biopsy revealed small cell carcinoma. After receiving 200G of external beam RT to the endobronchial lesion and 1 cycle of chemotherapy she developed worsening respiratory distress and left sided chest pain. CXR revealed left sided spontaneous pneumothorax. The pneumothorax was evacuated with a chest tube (17 Fr) and resulted in complete lung expansion.

DISCUSSION: There have been many mechanisms which have been postulated to be responsible for the production of spontaneous pneumothorax associated with lung cancer. In a large centrally located tumor causing complete or near complete obstruction, post chemo radiation shrinkage of the tumor and partial resolution of obstruction leads to a check-valve effect, with subsequent air-trapping alveolar hyperinflation and rupture. Most authors postulate that the spontaneous pneumothoraces are either random unrelated events or epiphenomenon which may be related to underlying smoke related sub pleural blebs or emphysematous bullae. Very few studies have reported spontaneous pneumothorax in primary small cell lung carcinoma following chemo radiation. Based on a few published studies, increased association of pneumothorax has been described in patients who received molecular target-based drugs or stereotactic radiosurgery. Therefore, the incidence of treatment associated pneumothorax in patients with primary pulmonary malignancy is likely to increase.

CONCLUSIONS: In patients with primary lung cancer who develop dyspnea and chest pain while receiving chemoradiation, pneumothorax should be considered as a reversible treatable cause of dyspnea. Prompt recognition and evacuation by chest tube placement can effectively palliate dyspnea. Patients with pneumothorax associated with treatment for primary pulmonary malignancy are at a risk of requiring prolonged chest tube drainage. Although rare, pneumothorax should be considered while explaining the risks and complications of chemoradiation.

1) Pneumothorax associated with treatment for pulmonary malignancy. T Maniwa* etal. Journal of Interactive CardioVascular and Thoracic Surgery 13 (2011) 257-261

DISCLOSURE: The following authors have nothing to disclose: Praveen Jinnur, Viswanath Vasudevan, Farhad Arjomand, Rana Ali, Tarkeshwar Tiwary, Vijaykumar Vanam, Abbas Qammar

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The Brooklyn Hospital Center, Brooklyn, NY




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