A case of spontaneous pneumothorax following radiation therapy for non-small cell lung cancer

Bhardwaj, Himanshu; Bhardwaj, Bhaskar; Youness, Houssein

doi:10.4103/0970-2113.120624

Cited by 4 publications

(7 citation statements)

References 11 publications

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“…In one previously reported case study, the pneumothorax was diagnosed 16 months after radiation exposure (16). However, the current patient presented with recurrent spontaneous pneumothorax prior to a diagnosis of AS.…”

Section: Discussionmentioning

confidence: 62%

Chronic myeloid leukemia following repeated diagnostic X‑ray exposure for the treatment of recurrent spontaneous pneumothorax in a patient with ankylosing spondylitis: A case report and literature review

Gong

et al. 2017

Oncol Lett

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Abstract. Previous studies have indicated that X-ray irradiation may increase the risk of chronic myeloid leukemia (CML), and the incidence of spontaneous pneumothorax in patients with ankylosing spondylitis (AS) is higher than in the general population. Patients with AS usually develop spontaneous pneumothorax several years after the diagnosis of AS. The present study reports the unusual case and complicated clinical history of a 29-year-old man with recurrent pneumothorax and AS, who developed CML following repeated exposure to low doses of radiation via diagnostic X-rays and chest computed tomography imaging. Pneumothorax was diagnosed prior to AS in this patient; the present case report highlights the importance of recognizing AS as a possible underlying cause of recurrent spontaneous pneumothorax. Patients with AS may be more sensitive to injury via X-ray-derived radiation, and even small diagnostic doses may be associated with CML. Diagnostic X-ray exposure should therefore be limited to reduce the risk of radiation-associated malignancies, including CML, particularly in patients with AS. IntroductionAnkylosing spondylitis (AS) is a systemic, multifactorial, chronic rheumatic disease that affects the joints of the axial skeleton (1). A thorough physical examination, in conjunction with family history analysis, consideration of the patient's individual medical history, X-ray imaging and serum human leukocyte antigen (HLA)-B27 testing, is required for an accurate diagnosis (2). Previous research has indicated that the incidence of spontaneous pneumothorax in patients with AS is 0.29%, higher than that observed in the general population (1).Although the underlying etiology of spontaneous pneumothorax remains unknown, it is an uncommon lung disease that disrupts respiration in otherwise healthy men who tend to be tall and thin (3). Spontaneous pneumothorax results from the rupture of a subpleural emphysematous bleb typically located at the apex of the lung, leading to the accumulation of air in the pleural cavity (3). During the course of diagnosis and treatment, X-ray imaging is often utilized in patients with spontaneous pneumothorax (4).Chronic myeloid leukemia (CML) is characterized by the abnormal growth of mature myeloid cells; it has been associated with translocation involving chromosomes 9 and 22, resulting in the formation of the Philadelphia chromosome (5,6). The cause of this translocation is unknown, although exposure to ionizing radiation is likely to be a risk factor (7). Previous studies have demonstrated a dose-dependent risk of CML in patients with cancer who undergo radiation therapy (8,9) and experience repeated exposure to diagnostic radiography (7).Our previous report described the case of a patient with AS who was diagnosed with CML following repeated chest radiography and computed tomography (CT) (10); the report focused primarily on a possible association between low-dose X-ray-derived radiation exposure and CML. However, a recent follow-up revealed that this patient experienced mild l...

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Section: Discussionmentioning

confidence: 62%

Chronic myeloid leukemia following repeated diagnostic X‑ray exposure for the treatment of recurrent spontaneous pneumothorax in a patient with ankylosing spondylitis: A case report and literature review

Gong

et al. 2017

Oncol Lett

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“…Spontaneous pneumothorax is unusual and the majority of cases in the medical literature have been reported in patients receiving mantle irradiation for lymphoma [9]. Pezner et al reported the incidence of pneumothorax after mantle irradiation at 2.2% in Hodgkin's disease patients without concurrent lung disease [10].…”

Section: Discussionmentioning

confidence: 99%

“…Radiation induced pulmonary changes involving predominantly the apical pleura and parenchymal injury may be responsible [15]. Focal emphysema and fibrosis due to radiation therapy increases the chance of the formation and rupture of subpleural blebs [9]. Furthermore, increased tissue traction due to fibrosis can lead to the development of pneumothorax [16].…”

Section: Discussionmentioning

confidence: 99%

Simultaneous bilateral spontaneous pneumothorax and radiation pneumonitis following thoracic radiotherapy for the treatment of high grade follicular lymphoma

Mudawi¹,

Mamadigi²

2018

J Case Rep Images Oncology

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Introduction: spontaneous pneumothorax is a potentially life-threatening condition but an under-recognised and rarely described complication of thoracic radiotherapy. We report a case of bilateral spontaneous pneumothoraces and radiation pneumonitis following moderate dose of thoracic radiation to the spine for high grade follicular lymphoma. case report: A 66-year-old caucasian male, non-smoker and no pre-existing pulmonary pathology, was diagnosed with low grade follicular lymphoma in 1999 and treated with chlorambucil and dexamethasone, followed by 30Gy radiotherapy to para-aortic lymph nodes. A subsequent relapse in 2005 was treated with a further eight cycles of chlorambucil and dexamethasone followed by radiotherapy to the pelvis. A second relapse in 2009 was managed with eight cycles of cyclophosphamide, vincristine and prednisolone and rituximab (cVP-r), followed by two years of maintenance rituximab. In 2016, the patient presented with thoracic back pain. Magnetic resonance imaging (MrI) demonstrated diffuse bony metastasis particularly at levels t2-t4 compressing the spinal cord that was decompressed surgically. biopsy confirmed diffuse large b-cell lymphoma.

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“…Most reported cases of spontaneous pneumothorax following radiotherapy are Hodgkin's disease caused by mantle irradiation [6]. Spontaneous pneumothorax following radiotherapy in lung cancer has rarely been reported [6][7][8][9][10][11].…”

Section: Discussionmentioning

confidence: 99%

“…Although a number of different mechanisms have been proposed to underlie pneumothorax with malignancies , the pathogenesis leading to spontaneous pneumothorax following radiotherapy has not been defined . There are three putative mechanisms : first, radiation‐induced pulmonary changes, as well as apical pleural and parenchymal injury, might induce focal emphysema and fibrosis, which might rupture subpleural blebs .…”

Section: Discussionmentioning

confidence: 99%

Spontaneous pneumothorax due to bronchopleural fistula following reirradiation for locoregionally recurrent squamous cell lung cancer

Ota

Suzumura

Sugiura

et al. 2016

Clinical Case Reports

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A case of spontaneous pneumothorax following radiation therapy for non-small cell lung cancer

Cited by 4 publications

References 11 publications

Chronic myeloid leukemia following repeated diagnostic X‑ray exposure for the treatment of recurrent spontaneous pneumothorax in a patient with ankylosing spondylitis: A case report and literature review

Chronic myeloid leukemia following repeated diagnostic X‑ray exposure for the treatment of recurrent spontaneous pneumothorax in a patient with ankylosing spondylitis: A case report and literature review

Simultaneous bilateral spontaneous pneumothorax and radiation pneumonitis following thoracic radiotherapy for the treatment of high grade follicular lymphoma

Spontaneous pneumothorax due to bronchopleural fistula following reirradiation for locoregionally recurrent squamous cell lung cancer

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