Angiosarcoma of the Lower Extremity presenting as Bilateral Pneumothoraces

Spontaneous pneumothorax usually presents as unilateral disease. Bilateral spontaneous pneumothoraces are less common and are more likely to be secondary than primary. We describe a case of bilateral spontaneous pneumothoraces that were resistant to conventional treatment, and found ultimately to be secondary to angiosarcoma of the lower extremity. A previously well 49 year old white female was referred to our institution in London with bilateral pneumothoraces. A left video assisted thoracoscopic procedure was undertaken, and the wedge resection of the lung specimen contained an area of metastatic tumor. Talc was placed into the left pleural cavity; talc was also placed at the bedside into the right pleural cavity which was slow to heal, and required a second chest tube and Heimlich valve. The pneumonthoraces were eventually found to be secondary to metastatic angiosarcoma of the thigh. A groin mass was biopsied and found to be the source of the metastatic deposits. This was not present on initial examination. The patient was referred for chemotherapy to a specialized sarcoma unit. Spontaneous pneumothorax may be the first and only evidence for pulmonary metastases. This report highlights the importance of considering an underlying pathology in patients presenting with spontaneous bilateral pneumothoraces.