Spontaneous pneumothorax in the elderly: a sign of a malignancy?

Kolbas, Ilker; Evman, Serdar; Tezel, Çağatay; Citak, Sevinc; Metin, Serda Kanbur; Alpay, Levent; Kıral, Hakan; Baysungur, Volkan

doi:10.1177/0218492319831840

Cited by 7 publications

(5 citation statements)

References 9 publications

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“…We suggest that the cases of spontaneous pneumothorax observed in elderly patients should be carefully evaluated in more detailed studies, and further investigations must be carried out with suspicion of underlying pulmonary malignancy or spontaneous rib fracture that due to multiple myeloma. 10 for pneumothorax.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Spontaneous pneumothorax revealing multiple myeloma: a case report

Brahem,

BenTekaya,

Touil

et al. 2023

F1000Res

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Various causes like trauma, infection, pulmonary disease or neoplasm can lead to spontaneous pneumothorax. We report a rare case of a spontaneous pneumothorax as first manifestation of multiple myeloma. A 58-year-old patient presented suffering from dyspnea and right-sided chest pain, with no history of trauma. On examination, the patient had bilateral rib tenderness. The respiratory rate was 30 breaths/min and oxygen saturation was 88%. The chest physical exam revealed unequal breath sounds, an hyperresonance with percussion and decreased wall movement on the right side. The analysis of arterial blood gas revealed hypoxemia (arterial oxygen tension: 7.59 kPa) and hypercapnia (arterial carbon dioxide tension: 5.99 kPa). Laboratory data showed a raised C reactive protein level (133.8 mg/L), hyper-calcemia (serum calcium: 12.18 mg/dL) and a decreased plasma albumin level (31.9 g/L). The hemoglobin rate was 13.4 g/dl and the serum creatinine.was normal at 34 µmol/l. Chest radiography and thoracic computed tomography revealed multiple ribs and sternum fractures leading to a partial pneumothorax on the right side. Subsequent workup for multiple myeloma showed elevated levels of immunoglobulin. Results of initial laboratory tests revealed an IgG gamma paraprotein, a urine protein electrophoresis of 1450 mg/24 hours and a β-2 microglobulin rate of 3.35. The diagnosis of multiple myeloma was confirmed with a bone marrow infiltration of 20% of atypical plasmatic cells. Cytogenetic investigations with FISH method did not show any chromosomal abnormalities, especially the t (4,14) translocation. The patient was diagnosed with multiple myeloma stage IIIA according to Durie–Salmon classification. Appropriate treatment with oxygen therapy and systemic analgesic was started, associated with a cure of zoledronic acid in order to decrease the calcium level. The evolution was characterized by the complete resolution of the pneumothorax in 7 days, the hypoxemia due to pneumothorax was improved and the calcium level was ormalized. The autologous stem cell transplant was the treatment of choice for this patient.

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Section: Discussionmentioning

confidence: 99%

Case Report: Spontaneous pneumothorax revealing multiple myeloma: a case report

Brahem,

BenTekaya,

Touil

et al. 2023

F1000Res

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Case Report: Spontaneous pneumothorax revealing multiple myeloma: a case report

et al. 2023

View full text Add to dashboard Cite

Various causes like trauma, infection, pulmonary disease or neoplasm can lead to spontaneous pneumothorax. We report a rare case of a spontaneous pneumothorax as first manifestation of multiple myeloma. A 58-year-old patient presented suffering from dyspnea and right-sided chest pain, with no history of trauma. On examination, the patient had bilateral rib tenderness. The respiratory rate was 30 breaths/min and oxygen saturation was 88%. The chest physical exam revealed unequal breath sounds, an hyperresonance with percussion and decreased wall movement on the right side. The analysis of arterial blood gas revealed hypoxemia (arterial oxygen tension: 7.59 kPa) and hypercapnia (arterial carbon dioxide tension: 5.99 kPa). Laboratory data showed a raised C reactive protein level (133.8 mg/L), hyper-calcemia (serum calcium: 12.18 mg/dL) and a decreased plasma albumin level (31.9 g/L). Chest radiography and thoracic computed tomography revealed multiple ribs and sternum fractures leading to a partial pneumothorax on the right side. Subsequent workup for multiple myeloma showed elevated levels of immunoglobulin. Results of initial laboratory tests revealed an IgG gamma paraprotein, a urine protein electrophoresis of 1450 mg/24 hours and a β-2 microglobulin rate of 3.35. The diagnosis of multiple myeloma was confirmed with a bone marrow infiltration of 20% of atypical plasmatic cells. Cytogenetic investigations did not show any chromosomal abnormalities, especially the t (4,14) translocation. The patient was diagnosed with multiple myeloma stage IIIA according to Durie–Salmon classification. Appropriate treatment with oxygen therapy and systemic analgesic was started, associated with a cure of zoledronic acid in order to decrease the calcium level. The evolution was characterized by the complete resolution of the pneumothorax in 7 days and the normalization of the calcium level. The autologous stem cell transplant was the treatment of choice for this patient.

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“…Localized mesothelioma and lung cancer rarely present as bullous/cystic lesions leading to pneumothorax, particularly in aged patients 7 , 8 . However, immunostains and molecular features can rule out the possibility of a sarcomatoid mesothelioma or carcinoma.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, primary pleuropulmonary tumors presenting with pneumothorax rarely appear as localized bullous disease making impossible its suspicion at imaging studies 7 , 8 . We describe herein an exceedingly uncommon primary cystic synovial sarcoma of the lung unexpectedly discovered on bullectomy after recurrent episodes of pneumothorax.…”

Section: Introductionmentioning

confidence: 99%

An unexpected cause of recurrent pneumothorax

Rossi¹,

Farnedi²,

Davoli³

et al. 2022

Pathologica

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Summary The thoracic district is the most frequent visceral location of synovial sarcoma, generally involving lung and pleura as a large solid mass. We present herein a 57-year-old man with recurrent pneumothorax and a localized bulla at the lingula. The lesion was excised by a Video-Assisted-Thoracoscopic-Surgery (VATS) wedge resection and surprisingly consisted of a unilocular cyst with fibrous wall intermingled by a longitudinal proliferation of bland-looking, dense, monomorphic spindle cells diffusely expressing EMA, CD99, CD56 and focally staining with cytokeratins. Fluorescent in situ hybridization demonstrated the presence of SYT rearrangement and a diagnosis of pulmonary cystic monophasic synovial sarcoma was made. Only few similar cases have been reported in literature, mainly occurring in young male adults. A meticulous examination of all resected tissue from pneumothorax is the prerequisite to suspect this extremely challenging condition, while immuno-molecular studies are mandatory to achieve the correct diagnosis.

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Spontaneous pneumothorax in the elderly: a sign of a malignancy?

Cited by 7 publications

References 9 publications

Case Report: Spontaneous pneumothorax revealing multiple myeloma: a case report

Case Report: Spontaneous pneumothorax revealing multiple myeloma: a case report

Case Report: Spontaneous pneumothorax revealing multiple myeloma: a case report

An unexpected cause of recurrent pneumothorax

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