Spontaneous pneumothorax as a first sign of pulmonary carcinoma
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Case report
Spontaneous pneumothorax as a first sign of pulmonary carcinoma Vladislavas Vencevičius*1 and Saulius Cicėnas1,2 Address: 1Department of Thoracic Surgery and Oncology, Institute of Oncology, Vilnius University, Santariškių 1, Vilnius, Lithuania and 2Vilnius University, Medical Faculty, Institute of Rehabilitation, Sport Medicine and Nursing, Vilnius, Lithuania Email: Vladislavas Vencevičius* - [email protected]; Saulius Cicėnas - [email protected] * Corresponding author
Published: 30 June 2009 World Journal of Surgical Oncology 2009, 7:57
doi:10.1186/1477-7819-7-57
Received: 27 March 2009 Accepted: 30 June 2009
This article is available from: http://www.wjso.com/content/7/1/57 © 2009 Vencevičius and Cicėnas; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: Spontaneous pneumothorax (SP) is a rare manifestation of lung cancer. The mechanisms by which pneumothorax occurs in lung cancer is not clear, resulting in different views being expressed. Case presentation: Here we present a case in which pneumothorax occurred as a first manifestation of lung cancer. The chest x-ray of a 68 year old man revealed a right partial pneumothorax. VATS was then performed: the visceral pleura lying over segment S3 was destroyed and air leaks were found in this section. Pathologic examination of the biopsy specimen revealed non-small cell carcinoma. Thoracoscopic talc pleurodesis was performed. Conclusion: Spontaneous pneumothorax in association with lung cancer is rarely seen. Pneumothorax can be the first sign of lung cancer. The most common possibility for SP complicating lung cancer is the tumor necrosis mechanism or, in separate cases, rupture of the emphysematous bullae. Lung cancer should always be considered as a possible cause of SP in elderly patients or in heavy smokers.
Background SP is generally attributed to a rupture of the sub-pleural blebs or emphysematous bullae [1]. This can complicate primary or secondary lung tumors. SP in primary pulmonary neoplasm or lung metastasis is very rare and the estimated rate of joint occurrence is approximated to be between 0,03 and 0,05 percent for primary lung cancer [15]. Pneumothorax due to primary lung cancer is also rare and prognosis is poor because most often the cancer is either at an advanced stage or the diagnosis of cancer was delayed [1,5].
days. He was a heavy smoker. Physical examination revealed tachycardia and tympanic percussion over the right chest, dullness with decreased breath sounds over the right lower chest. His chest radiograph of the thorax showed a lesion in the upper zone of the right lung and partial pneumothorax (Figures 1, 2). Routine investigations revealed Hb: 8%, TLC: 9700/ cumm, DLC: P62 L 38 cumin and ERS 20 mm in the first hour. Blood ur
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