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Disorders of the Pleura |

An Unusual Cause of Pneumothorax

Narendrakumar Alappan, MD; Creticus Marak, MD; Roshen Mathew, MD; Thomas Aldrich, MD
Chest. 2013;144(4_MeetingAbstracts):493A. doi:10.1378/chest.1704915
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Abstract

SESSION TITLE: Pleural Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Spontaneous pneumothorax can occur secondary to a variety of pulmonary disorders or iatrogenic. Spontaneous pneumothorax is a rare complication of chemotherapy for lung neoplasm.

CASE PRESENTATION: A 52-year old female, non smoker, with history of mild intermittent asthma and Metastatic Uterine Leiomyosarcoma presented with acute right sided chest pain and dyspnea of one days duration. She was diagnosed with uterine Leiomyosarcoma with pulmonary metastasis 3 months prior; for which she underwent total abdominal hysterectomy and bilateral salpingo-oopherectomy. After the surgery, she was initiated on chemotherapy with gemcitabine and docetaxel via a right sided port-a-catheter. At this presentation chest x-ray showed persistent bilateral pulmonary metastasis. CT angiogram revealed bilateral pulmonary metastatic disease with interval development of necrosis involving some of the metastatic lesions (Figure 1 (A and B), a small right pneumothorax:; with no evidence of pulmonary embolism. A diagnosis of a Spontaneous pneumothorax secondary to tumor lysis of sarcoma after chemotherapy was made.

DISCUSSION: The incidence of spontaneous pneumothorax is between 5 to 10 per 100,000 per year [1]. Primary spontaneous pneumothorax occurs due to rupture of sub-pleural blebs in patients with unrecognized lung disease. Secondary spontaneous pneumothorax occurs in patients with underlying lung disease, with COPD being the commonest etiology. A rare cause of secondary spontaneous pneumothorax is malignant lung disease particularly from Sarcoma. In a compilation of case report and case series by Hoag et al on one hundred and fifty three cases of pneumothorax complicating sarcoma, the most common cited cell types were osteogenic sarcoma, angiosarcoma (hemangioendothelioma) and synovial cell sarcoma[2]. Most common mechanisms leading to the development of pneumothorax are either tumor involvement of pleura or extension of cavitary tumor lesion to the pleural space which frequently might happen after chemotherapy. 38.1 % had received chemotherapy prior to the development of pneumothorax. There is a high recurrence rate of pneumothorax of 45.7% at an average of 61(±112) days. Most of the patients required one of the forms of treatment which included chest tube, thoracic surgery, pleurodesis or aspiration. The survival of patients with spontaneous pneumothorax in sarcoma patients is poor, particularly who were symptomatic and in those who did not have chest tube placement.

CONCLUSIONS: Spontaneous Pneumothorax from Primary lung or metastatic malignant disease is very rare.

Reference #1: Mason RJ,Broaddus VC, Murray JF, Nadel JA, eds. Murray and Nadel’s Textbook of Respiratory Medicine. 4th ed.Philadelphia, PA:Elsevier Saunders;2005

Reference #2: Hoag JB, Sherman M, Fasihuddin Q, Lund ME. A comprehensive review of spontaneous pneumothorax complicating sarcoma. Chest. 2010 Sep;138(3):510-8. doi: 10.1378/chest.09-2292. Epub 2010 Apr 9. Review. PubMed PMID: 20382720.

DISCLOSURE: The following authors have nothing to disclose: Narendrakumar Alappan, Creticus Marak, Roshen Mathew, Thomas Aldrich

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