Bilateral recurrent pneumothorax complicating chemotherapy for pulmonary metastatic breast ductal carcinoma: Report of a case

Abstract

Secondary spontaneous pneumothorax (SSP) is a rare complication of chemotherapy for pulmonary metastases and to the best of our knowledge, only 28 cases have been described, most of which occurred in patients with osteosarcoma or germ cell tumors. We present herein the case of a 56-year-old woman in whom bilateral and recurrent SSP was caused by the rupture of pulmonary lacunae induced by chemotherapy, given for bilateral lung metastases secondary to breast carcinoma. Our experience of this case led us to conclude that: patients with pulmonary metastases may develop bilateral and/or recurrent pneumothoraces following chemotherapy; computed tomography scan is essential for defining the cause of SSP; and closed chest tube drainage remains the therapy of choice, while chemical pleurodesis may also be used to prevent recidivant SSP.

Bilateral Pneumothorax: A Retrospective Analysis of 40 Patients

“…2 Although most reported cases are associated with malignancy, [3][4][5] in our series 30 were traumatic, 9 were spontaneous, and 1 was iatrogenic.…”

Docetaxel (Taxotere®)-induced cavitary change of pulmonary metastatic lesions complicated by bilateral spontaneous pneumothoraces in a patient with primary adenocarcinoma of the lung

“…Several reports in the literature have described more severe sequelae of spontaneous pneumothorax, which required interventions such as closed chest tube drainage and chemical pleurodesis. (2,7) We therefore recommend that patients with cavitary changes in their pulmonary metastatic lesions after chemotherapy be informed of the risk of developing pneumothorax, and that regular follow-up chest radiography be performed on these patients.…”

“…(1) It is rarely encountered in cancer patients after chemotherapy, (1,2) and the mechanism by which pneumothorax develops in lung cancer has yet to be elucidated. Herein, we describe a case of bilateral spontaneous pneumothoraces after administration of docetaxel for primary lung adenocarcinoma with metastases.…”

Spontaneous Pneumothorax in Children with Osteosarcoma: Report of Three Cases and Review of the Literature

“…Although the exact mechanism of the pneumothorax in metastatic cases is unknown, several mechanisms have been proposed : a) Constitution of a fistula between parenchyma and pleura due to necrosis of a subpleural tumoral nodule, secondary to vascular lesion or chemotherapy ; b) Partial bronchial obstruction by a tumor nodule acting as a valve with alveolar distension, dehiscence of alveolar walls, and passage of air in interlobular septa to the pleura, forming blebs that can break ; c) Tumor emboli with infarction and necrosis ; d) Tumoral infiltration of the wall of a preexisting benign cavity and rupture into the pleural space ; and e) Increased intrathoracic pressure following emetogenic chemotherapy (27,28). Increased intrathoracic pressure following emetogenic chemotherapy can also be a predisposing factor.…”