Author Credentials

Mark H. Cooper MD, PhD





Spontaneous pneumothorax usually presents as unilateral disease. Bilateral spontaneous pneumothoraces are less common and are more likely to be secondary than primary. We describe a case of bilateral spontaneous pneumothoraces that were resistant to conventional treatment, and found ultimately to be secondary to angiosarcoma of the lower extremity. A previously well 49 year old white female was referred to our institution in London with bilateral pneumothoraces. A left video assisted thoracoscopic procedure was undertaken, and the wedge resection of the lung specimen contained an area of metastatic tumor. Talc was placed into the left pleural cavity; talc was also placed at the bedside into the right pleural cavity which was slow to heal, and required a second chest tube and Heimlich valve.

The pneumonthoraces were eventually found to be secondary to metastatic angiosarcoma of the thigh. A groin mass was biopsied and found to be the source of the metastatic deposits. This was not present on initial examination. The patient was referred for chemotherapy to a specialized sarcoma unit. Spontaneous pneumothorax may be the first and only evidence for pulmonary metastases. This report highlights the importance of considering an underlying pathology in patients presenting with spontaneous bilateral pneumothoraces.

Conflict(s) of Interest


References with DOI

1. Grigorescu C, Bosanceanu M, Boisteanu D, Aldea A, chiselita I, Cozma LG. Lymphangioleiomyomatosis (LAM)—an uncommon cause of bilateral spontaneous pneumothorax.

2. Tan C, Treasure T, Browne J, Utley M, Davies CW, Hemingway H. Appropriateness of VATS andbedside thoracostomy talc pleurodesis as judged by a panel using the RAND/UCLA appropriateness method (RAM). Interact Cardiovasc Thorac Surg 2006;5(3):311-6. https://doi.org/10.1510/icvts.2005.123919

3. Fedok FG, Levin RJ, Maloney ME, Tipirneni K. Angiosarcoma: current review. Am J Otolaryngol 1999;20(4):223-31.

4. Sakurai H, Hada M, Miyashita Y, Tsukamoto K, Oyama T, Ashizawa I. Simultaneous bilateral spontaneous pneumothorax secondary to metastatic angiosarcoma of the scalp: report of a case. Surg today 2006; 36 (10) :919-22. https://doi.org/10.1007/s00595-006-3267-9

5. Lawton PA, Knowles S, Karp SJ, Suvana SK, Spittle MF. Bilateral pneumothorax as a presenting feature of metastatic angiosarcoma of the scalp. Br J Radiol 1990;63(746):132-4. https://doi.org/10.1259/0007-1285-64-757-72-a

6. Shioya H, Akiba T, Ohki T, Kurihara H, Kohno M, Miura K, Ujiie H, Sakurai K. Case report of metastatic cutaneous angiosarcoma causing bilateral pneumothorax. Nihon Kyobu Shikkan Gakkai Zasshi 1993;31(4):489-500.

7. Chen W, Shih CS, Wang YT, Tseng GC, Hsu WH. Angiosarcoma with pulmonary metastasis presenting with spontaneous bilateral pneumothorax in an elderly man. J Formos Med Assoc 2006;105(3):238-41. https://doi.org/10.1016/s0929-6646(09)60312-0

8. Lee CH, Park KU, Nah DY, Won KS. Bilateral spontaneous pneumothorax during cytotoxic chemotherapy for angiosarcoma of the scalp: a case report. J Korean Med Sci 2003;18(2):277-80. https://doi.org/10.3346/jkms.2003.18.2.277

9. Kader HA, Bolger JJ, Goepel JR. Bilateral pneumothorax secondary to metastatic angiosarcoma of the breast. Clin Radiol 1987;38(2):201-2.

10. Furer M, Althaus U, Ris HB. Spontanous pneumothroax from radiographically occult metastatic sarcoma. Eur J Cardiothorac Surg 1997;11:1171-3. https://doi.org/10.1016/s1010-7940(97)01164-0

11. Chang JH, Kim JH and Hong SH. Et al Angiosarcoma presenting with Spontaneous Hydropneumothorax. Report of a Case and review of the Literature. Open Respir Med J 2014; 26(8):48-54. https://doi.org/10.2174/1874306401408010048

Included in

Surgery Commons