Spontaneous Pneumothorax Following Chemotherapy for Malignant Pleural Mesothelioma with Diffuse Pulmonary Metastasis-A Case Report

惡性肋膜間皮瘤合併瀰漫性肺轉移於化學治療後併發自發性氣胸一病例報告

王保山(Pao-Shan Wang) ； 朱國安(Kuo-An Chu) ； 林秀玲(Shong-Ling Lin) ； 吳銘庭(Ming-Ting Wu) ； 賴瑞生(Ruay-Sheng Lai)

《胸腔醫學》 25卷4期 (2010/08) Pp. 216-221

https://doi.org/10.29806/TM.201008.0008

摘要

惡性肋膜間皮瘤是原發於肋膜腔間皮細胞的腫瘤，與石棉的曝露有關。惡性肋膜間皮瘤合併對側肺部轉移在文獻查證上非常罕見。接受化學治療後併發自發性氣胸的病例是少見的，但在多種腫瘤病人曾被報導過。惡性肋膜間皮瘤的病人接受化學治療後併發自發性氣胸在文獻上尚未被報導。本文描述一名54歲男性患有右側惡性肋膜間皮瘤病人，接受化學治療七天後出現呼吸困難惡化的症狀。胸部電腦斷層影像顯示新形成的雙側瀰漫性肺結節及左側多發性肋膜下結節併左側氣胸。根據化學治療的時間關聯性及胸部電腦斷層影像之證據，診斷為惡性肋膜間皮瘤合併瀰漫性肺部轉移，經化學治療後併發自發性氣胸。經胸管引流及後續肋膜沾黏治療後氣胸的症狀解除。此時，病人選擇支持性療法而不願再接受化治療。病患於三個月後死亡而無復發自發性氣胸。此病例提醒臨床醫師，惡性肋膜間皮瘤合併肺部轉移的病人接受化學治療後，若發生急性呼吸困難的症狀，應考慮自發性氣胸之可能性。

關鍵字

化學治療 ； 惡性肋膜間皮瘤 ； 自發性氣胸

並列摘要

Malignant pleural mesothelioma (MPM) is an asbestos-associated neoplasm that arises from mesothelial surfaces of the pleural cavities. Contralateral pulmonary metastasis in MPM, although reported, is unusual. Spontaneous pneumothorax (SP) following chemotherapy for malignancy is relatively rare, but has been reported in patients with a variety of tumors. To the best of our knowledge, SP occurring as a complication of chemotherapy in patients with MPM has not been reported before. In this report, we described a 54-year-old man with right-sided MPM who underwent combination chemotherapy with cisplatin and pemetrexed. Seven days after chemotherapy, he presented with an acute onset of worsening dyspnea with left pneumothorax. A computed tomography (CT) scan of the chest revealed right pleural-based masses, numerous newly developed bilateral pulmonary nodules and multiple subpleural nodules of the left lung with pneumothorax. The new development of numerous bilateral pulmonary nodules in this patient was believed to have been caused by the MPM, including contralateral pulmonary metastasis. Based on the temporal relationship to chemotherapy and the multiple subpleural nodules demonstrated by chest CT, chemotherapy-induced pneumothorax was considered. A chest tube was inserted and the dyspnea improved. Chemical pleurodesis was performed after complete expansion of the left lung. At that point, the patient opted for palliative care and refused further chemotherapy. He died less than 3 months later without recurrence of SP. In patients with pulmonary metastasis from MPM, the acute onset of dyspnea following chemotherapy should alert clinicians to the possibility of SP. Chest tube insertion and subsequent pleurodesis should be arranged properly and immediately.

並列關鍵字

chemotherapy ； malignant pleural mesothelioma ； spontaneous pneumothorax