Bilateral spontaneous pneumothorax during cytotoxic chemotherapy for angiosarcoma of the scalp: a case report

Spontaneous pneumothorax is a rare manifestation of metastatic lung cancers and described in advanced diseases or during cytotoxic chemotherapy which is manifested by sudden onset of dyspnea. The cause or mechanism of spontaneous pneumothorax has been unknown, as well as the association with site of metastases or type of cancers or side effect of chemotherapeutic drugs has been reported rarely. A 68-yr-old man underwent excision of angiosarcoma of the scalp. Chest radiography did not show any evidence of possible metastatic lung lesion at that time. Therefore, systemic doxorubicin and dacarbazine were given. After nineteen days of chemotherapy, he developed a bilateral spontaneous pneumothorax and palpable cervical lymph nodes. Both parietal and visceral pleura were intact and showed no evidence of metastatic and pathologic lesions on thoracoscopic evaluation. The patient managed with bilateral tube thoracostomy and both lungs were expanded. Lymph nodes became unpalpable during three cycles of the paclitaxel and doxorubicin, however, bilateral lung metastases were developed and progressed despite chemotherapy. The patient died due to respiratory failure after five months. This report underlines that spontaneous pneumothorax can occur as the first manifestation of metastatic angiosarcoma even if imaging studies do not show of a metastatic lesion.