A Case of Delayed Metastatic Sarcoma of the Pleura, Illustrating the Diagnostic Value of Artificial Pneumothorax

Abstract

Diagnostic pneumotliorax is not a new procedure, but most of the publications which have appeared since Brauer (1) first advocated its use in 1912 have dealt with the demonstration of mediastinal and pulmonary parenchymal lesions. The eaRe with which pleural adhesioiis could be visualized suggested the use of this technic in the diagnostic study of non-inflammatory diseases of the pleura, but only a few authors have presented cases wherein roentgenograms of the chest made after artificial lung collapse clearly revealed pleural neoplasm (2, 3 j. Artificial pneumothorax would seem particularly applicable to the study of pleural effusions of obscure origin because of the virtual worthlessness of ordinary roentgenograms in the face of massive opacity. I n view of the common associatioii between intrathoracic neoplasm and pleural effusion (4) it is probable that diagnostic opportunities are lost through failure to pse a procedure which is simple and safe in competent hands.The following case report is a pertinent illustration of the worth of this method. Moreover, it presents a death from metastatic sarcoma thirteen years after the appearance of the primary bone lesion, an event which seems worthy of emphasis in view of Crowell's recent analysis of the Bone Sarcoma Registry data (5). Case ReportR. H., a white male aged twenty-eight, was admitted to the University Hospital in July 1931, stating that f o r approximately one year he had been troubled by a conwtant sense of pressure in the right chest, associated with attacks of severe pain in the same location, non-productive cough, and excessive fatigue. He believed that he hail had occasional fever but denied hemoptyYis and loss of weight. In 1919, following mild trauma to the left wrist, a tender swelling appeared a t the distal end of the left radius, but x-ray examination at the time W I~R understood by the patient to have been negative. The swelling disappeared within approximately one month.I n 19%1, however, a fracture was sustained at this site following a trivial blow, and x-ray studies then revealed definite osteoporosis in the region of the fracture site. Open reduction was performed, and upon a portion of the removed tissue Dr. Alfred Scott Warthin returned the following opinion : "Alveolar spindle-cell sarcoma" (Fig. 1). Radium implantation and deep x-ray therapy in unknown quantity were employed, but by 1923 SO large a mass had developed that amputation through the mid-shaft of the humerus was carried out. The operative site healed primarily, and the patient was without 1 We are indebted to Dr. John B. Barnwell for permission to report this came. 334