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Weekly Chest CasesArchive of Old Cases

Case No : 495 Date 2007-04-23

  • Courtesy of Soo-Youn Ham, M.D. / Korea Univ. Anam Hospital College of Medicine, University of Korea
  • Age/Sex 71 / M
  • Chief ComplaintSudden developed dyspnea
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Angiosarcoma metastasis, Scalp mass excision 2 mo ago confirmed as angiosarcoma
Radiologic Findings
- Simple radiography of chest revealed small amount pneumothorax, left and cystic lesions, RML, RLL fields.

- Chest CT scan two weeks before simple radiography revealed well defined cystic lesions, right lungs with small amount pneumothorax and chest tube is inserted, left hemithorax.

- Histopathology: Scalp excision- Angiosarcoma, Wedge resection of LLL - Angiosarcoma, metastatic
Brief Review
- Highly malignant neoplasm, which most often develops on the scalp or face of elderly people.

- Common distant metastatic sites include the lung, liver, lymph nodes, and skin.

- Less than 1% of all spontaneous pneumothorax are tumor-associated.

- Cavitary pulmonary metastases related with squamous cell carcinoma from head and neck and ut. cervix.

- Angiosracoma metastases from scalp has higher prevalence of metastatic pulmonary complications.

- The underlying diseases, most commonly causes simultaneous bilateral spontaneous pneumothorax is the proliferation of mesencymal cells, as in sarcoma and histiocytosis X.

- The prognosis caused by metastatic pulmonary angiosarcoma is usually poor.
Please refer to
Case 487,
References
1. Weiss SW, Goldblum JR. Malignant vascular tumors: In: Weiss SW, Goldblum editors. Enzinger and Weisss soft tissus tumors. 4th ed. St. Louis:Mosby;2001.p.641-22

2. Sakurai H, Yoshihiro M, Tsukamoto K, et al. Simultaneous bilateral spontaneous pneumothorax secondary to metastatic angiosarcoma of the scalp. Sur Today 2006;36:919-922

3. Brandstetter RD. Simultaneous bilateral pneumothorax. Its bite is worse than its bark. Chest 1994;106:4-5
Keywords
Lung, Malignant tumor,

No. of Applicants : 62

▶ Correct Answer : 18/62,  29.0%
  • - Jikei University of Medicine, Japan Shigeki Misumi
  • - Akdeniz University School of Medicine, Radiology Dept Antalya, Turkey Gokhan Arslan
  • - Ewha Womans University MokDong Hospital, Korea Yoo Kyung Kim
  • - CHRU Lille hopital calmette, France Toledano Manuel
  • - Asan Medical Center, Korea Eun Jin Chae
  • - Dept of Radiodiagnosis, SSG Hospital & Medical College, Vabodara (GUJ), India M P Swami
  • - Osaka University, Japan Osamu Honda
  • - CHU Grenoble, France Bing Fabrice
  • - Yongsan Hospital, College of Medicine, Chung-Ang University, Korea Jae Seung Seo
  • - AL swaida national hospital, Syria Marwan al chami
  • - IRSA, La Rochelle, France Denis Chabassiere
  • - ASCS, Safwa, Saudi Arabia Kalari Adinarayana
  • - Anne Fontine Nimes Hospital, France Stephanie David
  • - Vital imaging centre, mumbai, India Ganesh Agrawal
  • - Dongguk University International Hospital, Korea Hee Seok Choi
  • - Nassau, Bahamas Trupti Dabholkar
  • - E-Da hospital, Taiwan Yu-Feng Wei
  • - Aims, New Delhi, India Ashish Gupta
▶ Correct Answer as Differential Diagnosis : 16/62,  25.8%
  • - Depart of radiology, Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
  • - Hae Jung Hospital, Korea Jeong Hwa Kong
  • - Sctimst trivandrum, kerala, India Santhosh Kumar
  • - Regional Imaging Riverina, Australia Rashid Hashmi
  • - Deptt. of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India Ram Prakash Galwa
  • - Ealing hospital,London, U.K. Shekhar Banavali
  • - ANNEMASSE, Polyclinique de SAVOIE, France Gay-Depassier Philippe
  • - IRSA La Rochelle, France Jean-Luc BIGOT
  • - Annecy hospital, France Gilles Genin
  • - Hospital Sotiria, Athens, Greece Vasilios Tzilas
  • - Homs National Hospital, Homs - Syria Rami Abou Zalaf
  • - Kyunghee University Medical Center, Korea Su Youn Sim
  • - Balabhai Nanavati hospital, mumbai, India Susheel Kumar
  • - Yong Dong Severance Hospital, Yonsei University, Korea Yoo Jin Hong
  • - Doctors Hospital, Nassau, Bahamas N.B.S.Mani
  • - KAUMS, Kashan, Iran Ebrahim Razi
▶ Semi-Correct Answer : 4/62,  6.5%
  • - Resident of Department of radiology, Samsung medical center, Korea Jeon Tae Yeon
  • - Mackay Memorial Hospital, Taipei, Taiwan Chia-Fu Tsai
  • - National Taiwan University Hospital, Taipei, Taiwan Chin Chung Shu
  • - China Medical University Hospital, Taiwan Jun-Jun Yeh
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