Multiple Pleural Destruction Due to Pleural Dissemination of Pulmonary Carcinoma Originating From Pneumothorax

Abstract

48-year-old man was admitted to our hospital complaining of coughing, hemosputum, and dysnea. Chest roentgenography revealed left pneumothoax and pleural effusion (Fig 1), which was revealed to be alignant by cytologic examination and contained a high evel of hyaluronic acid (4,761 mg/mL). Primary lung arcinoma or mesothelioma was suspected. A drainage ube was placed in the left pleural cavity and 10 cmH2O uction was applied for 10 days. Surgery was scheduled ecause of prolonged air leakage, and the operation was one thoracoscopically. Multiple small nodules were bserved on the parietal and visceral pleura through the horacoscope, and these were partially resected. The athologic diagnosis was adenocarcinoma. Pulmonary stulas from which the air leaks had originated were ound in segments 2, 6, and 10. The fistulous portions howed destruction of the visceral pleura, and pleural efects were observed through the thoracoscope. The isceral pleura lying over segment 2 was destroyed and howed a crater-like hollow (shown by two arrows in Fig ). Air leaks were found in this section, and no bullae