Hendarsih Een, Fadjari Trinugroho H, Oehadian Amaylia
Department of Internal Medicine, Hasan Sadikin Hospital, Bandung, Indonesia.
Acta Med Indones. 2016 Apr;48(2):134-8.
We present 2 patients who developed spontaneous pneumothorax (SP) following rapid regression of lymphoma and rhabdomyosarcoma with lung metastases. Case 1, a 43-year old man was admitted to our hospital with dyspnea 10 days before admission. He denied any recent trauma or previous treatment for lung tuberculosis. Three weeks prior to admission, he received first cycle of CHOP for non-Hodgkin's lymphoma stage II BE. Chest X-ray consistent with right pneumothorax. After treatment with chest tube drainage for about 1 month, the patient recovered and chemotherapy could be continued without further complications. Case 2, a 35- year old man was admitted to other hospital with dyspnea and chest pain on day 4 after second cycle of systemic combined chemotherapy for rhabdomyosarcoma stage IV (lung metastases) with doxorubicin, ifosfamide, mesna, and dacarbazine. Chest X-ray showed hydropneumothorax on right and left lung. After treatment with chest tube drainage about 2 weeks, the patient recovered and chemotherapy could be continued without further complications. The mechanism of pneumothorax following chemotherapy is not clearly understood yet, however, several hypotheses have been considered: 1) the rupture of a subpleural bulla after chemotherapy; 2) the rupture of an emphysematous bulla in an over expanded portion of the lung which is partially obstructed by a neoplasm; 3) tumor lyses or necrosis due to cytotoxic chemotherapy directly induces the formation of fistula. Dyspnea and chest pain suddenly appear during successful chemotherapy for metastatic chemosensitive tumors should alert the physician to the possibility of SP. The treatment is directed toward lung re-expansion. Chemotherapy induced pneumothorax should be considered as oncologic emergency.
我们报告了2例患者，他们在淋巴瘤和横纹肌肉瘤伴肺转移迅速消退后发生了自发性气胸（SP）。病例1，一名43岁男性，入院前10天因呼吸困难入住我院。他否认近期有任何外伤史或既往有肺结核治疗史。入院前三周，他接受了针对II期BE非霍奇金淋巴瘤的首个周期CHOP化疗。胸部X线检查显示符合右侧气胸。经胸腔闭式引流治疗约1个月后，患者康复，化疗得以继续且无进一步并发症。病例2，一名35岁男性，在接受了多柔比星、异环磷酰胺、美司钠和达卡巴嗪联合全身化疗治疗IV期（肺转移）横纹肌肉瘤的第二个周期后第4天，因呼吸困难和胸痛入住其他医院。胸部X线检查显示右侧和左侧肺均有液气胸。经胸腔闭式引流治疗约2周后，患者康复，化疗得以继续且无进一步并发症。化疗后气胸的机制尚不清楚，然而，已经考虑了几种假说：1）化疗后胸膜下肺大疱破裂；2）肺部过度膨胀部分的气肿性肺大疱破裂，该部分被肿瘤部分阻塞；3）细胞毒性化疗导致的肿瘤溶解或坏死直接诱导瘘管形成。在对转移性化疗敏感肿瘤进行成功化疗期间突然出现呼吸困难和胸痛应提醒医生注意SP的可能性。治疗旨在使肺复张。化疗引起的气胸应被视为肿瘤急症。
