Spontaneous Pneumothorax Associated with Metastatic Sarcoma

Abstract

Spontaneous pneumothorax and interstitial emphysema have long been recognized in a variety of pathological conditions. Sarcomatous and carcinomatous pulmonary metastases are also common findings, yet the association of spontaneous pneumothorax with metastatic tumors in the lung is apparently a rare condition. So far as we know, the only cases recently studied were reported by Thornton and Bigelow (1) in 1944. The two cases reported by Thornton and Bigelow occurred in young males. In one case massive pneumothorax developed approximately five months following amputation of the forearm for a fibrosarcoma of the hand. In the other case the pneumothorax occurred approximately five months following disarticulation of the hip for an osteogenic sarcoma in the left femur. It was the opinion of the writers that necrosis of the metastatic tumors played an important part in the production of bronchopleural fistulae and pneumothorax. Observation of three cases of spontaneous pneumothorax associated with metastatic sarcoma in Percy Jones General Hospital within a relatively short period is considered to be of sufficient interest to warrant a detailed report. In many respects the cases here described are similar to those reported by Thornton and Bigelow. All the patients were young males; one had a fibrosarcoma primary in the neck, another an osteogenic sarcoma primary in the tibia, and the third an angiosarcoma primary in the retroperitoneal space. In all cases the extensive pulmonary metastases were recognized early in the course of the disease, and in each instance pneumothorax was known to exist for a period of weeks prior to death. Case I: White male, age 18. On Oct. 25, 1946, a right mid-thigh amputation was done for osteogenic sarcoma of the tibia. Examination of the specimen revealed invasion of the blood vessels of the lower thigh by tumor cells. The immediate postoperative course was uneventful. On Nov. 10, 1946, the patient experienced sharp chest pain, and a roentgenogram made at that time revealed a bilateral pneumothorax and several small metastatic tumor nodules in both lung fields. Several attempts were made to relieve the pneumothorax by thoracentesis, but following each withdrawal the pleural space refilled with air almost immediately (Fig. 1). In spite of the persistence of the pneumothorax, the patient's general condition remained good and, since he had been provided with a prosthesis, he regularly attended reconditioning and walking classes. He made rapid progress in the use of his prosthesis and continued ambulatory until Jan. 15, 1947, when he experienced an acute attack of dyspnea. From that date he failed rapidly and died on Feb. 7, 1947. The roentgenogram made just prior to his death showed a marked increase in the degree of pneumothorax and in the number and size of metastatic tumor nodules in both lungs (Fig. 2). Necropsy: The body was well developed and nourished.