Konstantinidou Maria, Theocharidou Christina Chrysanthi, Dimaki Anastasia, Emmanouilides Christos, Ampatzidou Fotini
Department of Respiratory Medicine, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, GRC.
Intensive Care Unit, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, GRC.
Cureus. 2025 Apr 13;17(4):e82161. doi: 10.7759/cureus.82161. eCollection 2025 Apr.
Pneumothorax can be a rare but significant adverse event in patients with sarcoma and pulmonary metastases. This case report presents an instance of bilateral pneumothorax in a patient with metastatic leiomyosarcoma treated with pazopanib. A 74-year-old man with a history of grade 3 leiomyosarcoma and lung metastases was admitted with severe respiratory distress. He had been receiving pazopanib therapy following previous treatment with high-dose ifosfamide, doxorubicin, and radiotherapy. Imaging revealed bilateral pneumothorax, and the patient subsequently experienced respiratory arrest requiring immediate resuscitation measures including needle decompression followed by chest tube placement. The patient had experienced a unilateral pneumothorax two months prior to this presentation, which had resolved with standard interventions. While the bilateral pneumothorax eventually resolved after nine days of chest tube drainage, the patient exhibited no neurological recovery following the arrest, with brain imaging revealing bilateral cortical laminar necrosis. His clinical condition deteriorated significantly after 28 days in the intensive care unit (ICU), culminating in septic shock and death. This case highlights a serious pulmonary complication that can occur during the treatment of metastatic leiomyosarcoma, particularly in patients with lung metastases. The relationship between the development of pneumothorax and pazopanib therapy, along with the challenges in management and poor clinical outcome, merits consideration when treating similar patients.
气胸在患有肉瘤和肺转移瘤的患者中可能是一种罕见但严重的不良事件。本病例报告展示了一例接受帕唑帕尼治疗的转移性平滑肌肉瘤患者发生双侧气胸的情况。一名有3级平滑肌肉瘤病史和肺转移的74岁男性因严重呼吸窘迫入院。他在先前接受大剂量异环磷酰胺、阿霉素和放疗后一直在接受帕唑帕尼治疗。影像学检查显示双侧气胸，患者随后出现呼吸骤停，需要立即采取复苏措施，包括针吸减压，随后放置胸管。该患者在此次发病前两个月曾发生过单侧气胸，经标准干预后已缓解。虽然双侧气胸在胸管引流9天后最终得以缓解，但患者在呼吸骤停后未出现神经功能恢复，脑部影像学检查显示双侧皮质层状坏死。他在重症监护病房（ICU）住院28天后临床状况显著恶化，最终发展为感染性休克并死亡。本病例突出了转移性平滑肌肉瘤治疗期间可能发生的一种严重肺部并发症，尤其是在有肺转移的患者中。气胸的发生与帕唑帕尼治疗之间的关系，以及管理方面的挑战和不良临床结局，在治疗类似患者时值得考虑。
