HEAD ABOVE WATER: A RARE CASE OF SCALP ANGIOSARCOMA YIELDING SPONTANEOUS HYDROPNEUMOTHORAX

TOPIC: Pulmonary Manifestations of Systemic Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Angiosarcomas are rare, highly aggressive neoplasms originating from vascular or lymphatic endothelium [1]. Cutaneous angiosarcoma the scalp has a predilection to involve pleural/subpleural surfaces [2,3]. Able induce pneumothorax, hemothorax, and pleural effusion, few reports link cystic lung disease [3]. Herein, we present case cutaneous associated with hydropneumothorax. CASE PRESENTATION: An 80-year-old Asian man pertinent medical history smoking, atrial fibrillation, hypertension, coronary artery presented 2 weeks dyspnea cough. Additionally, he endorsed worsening large fungating lesion for past 3 months. Biopsy was diagnostic well-differentiated atypical cell scalp. This admission, CXR showed left-sided, moderate CT thorax revealed new cystic/cavitary bilaterally, not on prior imaging. The patient administered 100% FiO2 via NRB no resolution pneumothorax. Subsequent thoracocentesis produced exudate. Upon symptoms, bronchoscopy biopsy performed, chest tube placement drained voluminous serosanguinous fluid. BAL, quantiferon gold, AFBx2, fungal culture, ova/parasite all returned negative. No evidence metastatic resulted biopsy. stabilization without significant reaccumulation fluid/hydropneumothorax, discharged. Follow-up pulmonology/CVT recommended small-bore catheter possible pleurodesis. Eventually, fluid analysis identified presence nontuberculous mycobacteria. DISCUSSION: Constituting only 2% soft tissue sarcomas, propensity metastasize [2]. Our spontaneous hydropneumothorax metastases primary site. A series Japanese autopsy data compared vs. non-scalp angiosarcoma, in which pneumothorax solely observed patients subtype [4]. Only 24 cases have been reported 1978-2014, fewer documented since [5]. Limited linked hydropneumothorax, as seen our case. CONCLUSIONS: Angiosarcoma yield pulmonary sequelae. Considering scarcity cases, such diagnosis should be considered presenting eventual identification concurrent mycobacterium infection within is remarkable. Mycobacteria actuating unorthodox [6]. However, distinct etiology patient's presentation may multifactorial nature, compounding originality this REFERENCE #1: Somasekharan Nair KK, Zabell AS, Vo KL, Shaikh MA. Pneumothorax: classical angiosarcoma. Ann Thorac Surg. 2012 Sep;94(3):e77-8. doi: 10.1016/j.athoracsur.2012.02.030. PMID: 22916786.2. Andersen KF, Albrecht-Beste E, Berthelsen AK, Loft A. Scalp: Metastatic Cystic Lesions Initially Misinterpreted Benign Findings 18F-FDG PET/CT. Diagnostics (Basel). 2015 Dec 22;6(1):1. 10.3390/diagnostics6010001. 26838798; PMCID: PMC4808816. #2: Olsen D, Molloy C, Sriram PS. Rapidly progressive cysts effusion: report. Rep Pulmonol. 2011;2011:790274. 10.1155/2011/790274. Epub 2011 Sep 8. 22937430; PMC3420654.4. Kitagawa M, Tanaka I, Takemura T, Matsubara O, Kasuga T. scalp: report two fatal complications review registry data. Virchows Arch Pathol Anat Histopathol. 1987;412(1):83-7. 10.1007/BF00750735. 3120405. #3: Chang JH, Kim Hong SH, Song ME, Ryu YJ, Lee Shim SS, Cho MS, Sim YS. hydropneumothorax: literature. Open Respir Med J. 2014 26;8:48-54. 10.2174/1874306401408010048. 25614772; PMC4296473.6. Baldi BG, Carvalho CRR, Dias OM, Marchiori Hochhegger B. Diffuse diseases: differential diagnosis. J Bras Pneumol. 2017 Mar-Apr;43(2):140-149. 10.1590/S1806-37562016000000341. 28538782; PMC5474378. DISCLOSURES: relevant relationships by Nicholas Barreras, source=Web Response Azim Hemani, Michael Markos, Travis Yamanaka,