[Spontaneous hemothorax in a patient with lung metastases of osteosarcoma]

A 6-year-old girl with right lung metastases of osteosarcoma was scheduled for insertion of a central venous catheter and a femoral arterial catheter under general anesthesia for arterial injection chemotherapy. The central venous catheter was easily inserted through the right subclavian vein without arterial puncture. However, restlessness occurred on the first postoperative day. Chest X-ray examination revealed massive fluid collection in the right pleural space, which was identified as hemothorax by chest drainage. Chemotherapy started after the hemothorax had improved. However, restlessness occurred again on the 60 th postoperative day. Chest computed tomography examination revealed a right hemothorax and rupture of the growing lung metastatic tumor. Chest drainage was performed again. Some cases of pneumothorax complicated with rupture of lung metastases of osteosarcoma have been reported. Spontaneous rupture of lung metastases occurs regardless of tumor size, and occurs easily during chemotherapy because of necrosis of the tumor or disability of its repair function. In our case, rupture of the lung metastatic tumor involving tumor blood vessel was thought to have caused the hemothorax. Anesthesiologists should pay attention to spontaneous hemothorax in patients with lung metastases of osteosarcoma during whose perioperative management.