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Respiratory medicine
Rapidly progressive cystic lung disease in a patient with a scalp lesion
  1. Uddalak Majumdar,
  2. Muhammad Sameed,
  3. Sanjay Mukhopadhyay,
  4. Subha Ghosh,
  5. James K Stoller and
  6. Neal Chaisson
  1. Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr Uddalak Majumdar; majumdu{at}ccf.org

Abstract

We describe an elderly patient presenting with pneumothorax, cystic lung disease and a scalp lesion. The pneumothorax resolved after placing a chest tube and suction but recurred within a week. Progression of cystic features was also seen, and biopsies of the lung and scalp lesions were performed. Immunohistochemistry was positive for markers of endothelial cells (CD31 and ERG) and negative for markers expected to be positive in alveolar cells (keratin AE1/AE3 and TTF-1), supporting the diagnosis of metastatic angiosarcoma. Palliative chemotherapy did not prevent progression and the patient expired soon after. In describing the clinico-radiological correlation of metastatic angiosarcoma, we also briefly describe the approach to cystic lung disease. Understanding the pathophysiology of cyst formation in metastatic angiosarcoma may help clinicians to better appreciate and manage the full spectrum of cystic lung disease, especially with atypical features.

  • respiratory cancer
  • pneumothorax
  • air leaks

https://doi.org/10.1136/bcr-2023-258333

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    Footnotes

    • Contributors UM, Muhammad Sameed, SG, Sanjoy Mukhopadhyay, JKS and NC were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content. UM, MS, SG, SM JKS and NC authors gave final approval of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.