title: Angiosarcoma with pulmonary metastasis presenting with spontaneous bilateral pneumothorax in an elderly man.
abstract: Cutaneous angiosarcoma is a rare and invasive endothelial-derived sarcoma that occurs most frequently in the scalp and facial skin of elderly men. It is frequently accompanied by thin-walled cavitary pulmonary metastasis, and is often obscure on chest radiograph. We report a case of angiosarcoma of the scalp with cystic metastasis to the lung in a 63-year-old man, presenting as recurrent bilateral spontaneous pneumothorax. Lung metastasis was missed at the first episode of pneumothorax because the lung-expanded chest radiograph showed no significant abnormality. Two months later, bilateral pneumothorax recurred, and high-resolution computed tomography revealed multiple cystic, cavitary and nodular lesions. Pulmonary metastasis was confirmed by video-assisted thoracoscopic surgery, and pleurodesis was performed. After the operation, the patient received chemotherapy; no recurrence of pneumothorax was found during 6 months of follow-up. Pneumothorax in the elderly should be differentiated from malignant metastatic lung tumors.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
authors.forename: Chih-Shiun
authors.initials: CS
authors.lastname: Shih
authors.forename: Yao-Tung
authors.initials: YT
authors.lastname: Wang
authors.forename: Guan-Chin
authors.initials: GC
authors.lastname: Tseng
authors.forename: Wu-Huei
authors.initials: WH
authors.lastname: Hsu
mesh_terms: D006394:Hemangiosarcoma / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000556:secondary* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000209:etiology*; D012535:Scalp / Q000473:pathology; D012878:Skin Neoplasms / Q000473:pathology* / Q000628:therapy