Case Report

Recurrent Bilateral Spontaneous Pneumothorax Complicating Chemotherapy for Metastatic Sarcoma

Authors: Anupama Upadya, MD, Yaw Amoateng-Adjepong, MD, Raymond G. Haddad, MD

Abstract

We present the case of a 63-year-old woman with metastatic, high-grade pleomorphic sarcoma who had recurrent, bilateral pneumothorax while on a regimen of doxorubicin and dacarbazine. We postulate that her doxorubicin-based chemotherapy induced rapid cell lysis and necrosis of peripherally located, metastatic pulmonary nodules, leading to the pneumothoraces. Other potential mechanisms include bronchopleural fistula, rupture of dilated alveoli distal to a stenosis, chemotherapy-induced impairment of repair processes, and persistent local infection. Pneumothoraces related to pulmonary metastases tend to be refractory to conventional therapy and necessitate surgical intervention to prevent recurrences.

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