Yellin A, Benfield J R
Am Rev Respir Dis. 1986 Sep;134(3):590-2. doi: 10.1164/arrd.1986.134.3.590.
Pneumothorax in patients with lymphoma has rarely been reported. We have encountered 8 patients with lymphoma with 17 episodes of pneumothorax; these episodes occurred 3 months to 8 yr in 7 patients after the diagnosis of Hodgkin's disease (HD) and in 1 patient with non-Hodgkin's lymphoma (NHL). The observed incidence of pneumothorax among 1,977 patients with lymphoma was 10-fold higher than expected; this included a significantly higher incidence in patients younger than 30 versus those older than 30 yr of age (1:552 versus 1:5,788 patient-years, p less than 0.001), and a higher incidence in patients with HD than in those with NHL (1:708 versus 1:5,072 patient-years, p less than 0.005). There was a strong suggestion of increased risk for pneumothorax in patients treated with radiotherapy as compared with patients treated without irradiation (1:1,016 versus 0:1,963 patient-years, p = 0.065). Apparent additional contributing factors in 6 patients were lung involvement with lymphoma (n = 2), radiation fibrosis (n = 3), and infection (n = 1). Pneumothorax was persistent in 5 patients, bilateral in 4, and recurrent in 2. The occurrence of pneumothorax in 2 patients heralded death. Management commonly required placement of chest tube (n = 9) or major surgical procedures (n = 5). We conclude that pneumothorax may be more common among patients with lymphoma than previously appreciated. Young age, HD, and probably radiotherapy are predisposing factors. The pneumothoraces associated with lymphoma are more complex and ominous and more difficult to manage than the usual spontaneous pneumothorax. In patients with lymphoma, pneumothorax is likely to be secondary to underlying abnormality of the lung.
淋巴瘤患者并发气胸的情况鲜有报道。我们遇到了8例淋巴瘤患者，共发生17次气胸；这些气胸发作在7例霍奇金病（HD）患者诊断后3个月至8年出现，1例非霍奇金淋巴瘤（NHL）患者在诊断后出现。在1977例淋巴瘤患者中观察到的气胸发生率比预期高10倍；其中30岁以下患者的发生率显著高于30岁以上患者（每552患者年1例与每5788患者年1例，p<0.001），HD患者的发生率高于NHL患者（每708患者年1例与每5072患者年1例，p<0.005）。与未接受放疗的患者相比，接受放疗的患者发生气胸的风险有增加的强烈迹象（每1016患者年1例与每1963患者年0例，p = 0.065）。6例患者中明显的其他促成因素包括肺部受淋巴瘤累及（n = 2）、放射性纤维化（n = 3）和感染（n = 1）。5例患者气胸持续存在，4例为双侧气胸，2例复发。2例患者发生气胸后预示着死亡。治疗通常需要放置胸管（n = 9）或进行大型外科手术（n = 5）。我们得出结论，淋巴瘤患者气胸可能比以前认为的更常见。年轻、HD以及可能的放疗是诱发因素。与淋巴瘤相关的气胸比通常的自发性气胸更复杂、更凶险且更难处理。在淋巴瘤患者中，气胸很可能继发于肺部的潜在异常。
