Recurrent bilateral spontaneous pneumothorax complicating chemotherapy for metastatic sarcoma.
We present the case of a 63-year-old woman with metastatic, high-grade pleomorphic sarcoma who had recurrent, bilateral pneumothorax while on a regimen of doxorubicin and dacarbazine. We postulate that her doxorubicin-based chemotherapy induced rapid cell lysis and necrosis of peripherally located, metastatic pulmonary nodules, leading to the pneumothoraces. Other potential mechanisms include bronchopleural fistula, rupture of dilated alveoli distal to a stenosis, chemotherapy-induced impairment of repair processes, and persistent local infection. Pneumothoraces related to pulmonary metastases tend to be refractory to conventional therapy and necessitate surgical intervention to prevent recurrences.
D000208:Acute Disease; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001859:Bone Neoplasms / Q000473:pathology*; D015505:Chest Tubes; D003606:Dacarbazine / Q000008:administration & dosage; D004317:Doxorubicin / Q000009:adverse effects*; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000556:secondary*; D008875:Middle Aged; D018700:Pleurodesis; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D012008:Recurrence; D012509:Sarcoma / Q000150:complications / Q000188:drug therapy* / Q000556:secondary*; D020775:Thoracic Surgery, Video-Assisted; D013907:Thoracostomy; D013977:Tibia; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D004317:Doxorubicin