Spontaneous pneumothorax and pulmonary malignant disease--a syndrome sometimes associated with cavitating tumours. Report of nine new cases, four with metastases and five with primary bronchial tumours

Our plain-English summary of Spontaneous pneumothorax and pulmonary malignant disease--a syndrome sometimes associated with cavitating tumours. Report of nine new cases, four with metastases and five with primary bronchial tumours, by F.W. Wright (Clinical Radiology, 1976).

The study

• Author: F.W. Wright
• Journal: Clinical Radiology
• Published: 1976;27(2):211-22
• Type of article: Case report
• Cited by: 57 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 002316).

Abstract

Tumours of the lung, primary or secondary, may occasionally be complicated by a pneumothorax, and on rare occasions this may be the presenting feature. Metastatic tumours associated with pneumothorax arise usually from bone or soft tissue sarcomas and hence are more common in the young.

In plain English

This article from the Churchill Hospital, Oxford, described nine patients seen by the author who had a spontaneous pneumothorax (air leaking into the chest cavity, collapsing the lung) together with cancer in the lungs. It also reviewed published reports of this combination and of cavitating (hollowed-out) lung metastases. Four had cancer spread to the lungs from a muscle sarcoma, two osteogenic sarcomas and a kidney carcinoma. In three of these four, the pneumothorax affected both lungs. Five patients had primary bronchial tumours. One, a 71-year-old man, had been a heavy smoker and had worked with asbestos for two years at age 20; no fiber type was given. He had a left upper lobe mass and an air pocket at the top of that lung, described as a pneumothorax or possibly a large bulla. His case was headed as a slowly growing bronchial neoplasm or mesothelioma. In the author's experience, pneumothorax occurred in under 0.05% of primary bronchial tumour cases. The author wrote that it appeared more common with metastases, especially from sarcomas, and so in younger patients. The author concluded that more than one mechanism may cause the pneumothorax.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case series of nine patients from the author's own practice, combined with a review of published case reports of pneumothorax with lung tumours and of cavitating lung metastases
• Who was studied: Nine patients seen by the author at the Churchill Hospital, Oxford. Four had cancer that had spread to the lungs (aged 17, 17, 62 and 63), and five had primary bronchial tumours. Cases were seen between the 1960s and 1975.
• Exposure: The study was not about asbestos exposure. The conditions studied were lung metastases (from a muscle sarcoma, osteogenic sarcomas and an anaplastic renal carcinoma) and primary bronchial tumours. One patient (case 6) had been a heavy smoker and had worked with asbestos for two years at age 20. No fiber type or dose was given.
• Main results:
  • Case 6 was a 71-year-old man with a lobulated mass in the left upper lobe and an apparent loculated pneumothorax (or large bulla) at the top of the left lung. The case was headed as a slowly growing bronchial neoplasm or mesothelioma. Sputum tests for malignant cells were negative. Doctors thought he had a carcinoma of the left upper lobe.
  • Among the four patients with lung metastases, three (cases 1, 2 and 4) had pneumothoraces in both lungs. In case 2 the pneumothorax recurred several times.
  • In the author's own experience, spontaneous pneumothorax occurred in under 0.05% of patients with primary bronchial tumours.
  • With lung metastases, particularly from sarcomas, the author reported that pneumothorax appeared to be more frequent, and therefore to occur at a younger age.
  • The pneumothorax could appear before metastases were visible on a chest X-ray. In case 2 it preceded visible deposits for a number of months.
  • The author collected only eight cases of cavitating lung metastases in 14 years. This was despite about 1500 new cases registered each year in the Oxford Radiotherapy Department.
• The authors' conclusion: The author concluded that more than one mechanism may cause pneumothorax in patients with lung tumours.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Pneumothorax, Sarcoma.

Related studies

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• Simultaneous bilateral spontaneous pneumothorax in a patient with peritoneal and pleural papillary mesothelioma — P. Höllinger, D. Gaeng (1997)
• Malignant pleural mesothelioma presenting as spontaneous pneumothorax: a case series and review — S. Alkhuja, A. Miller, et al. (2000)
• Lung function 22-35 years after treatment of idiopathic spontaneous pneumothorax with talc poudrage or simple drainage — P. Lange, J. Mortensen, et al. (1988)
• Spontaneous pneumothorax and lung carcinoma: should one consider synchronous malignant pleural mesothelioma? — T.A. Flood, H.S. Sekhon, et al. (2009)
• Malignant pleural mesothelioma detected by spontaneous pneumothorax — A. Makidono, M. Matsusako, et al. (2010)

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