Bilateral talc pleurodesis in metastatic pneumothorax.

576 Communications to the Editor Communications for this section will be published as space and priorities permit. The comments should not exceed 350 words in kngth, with a maximum offive references; onefigure or table can be printed. Exceptions may occur under particular circumstance& Contributions may include comments on articles published in this periodical, or they may be reports ofunique educational character Specific permission to publish should be cited in a covering letter or appended as a postscript. reported the successful treatment of bilateral pneumothoraces secondary to metastatic leiomyosarcoma by tetracycline pleurodesis. This was the first such report in the literature. We have recently had a similar experience with a patient who developed bilateral pneumothoraces secondary to metastatic osteosarcoma treated by talc pleurodesis. A 12-year-old boy had a left forearm amputation performed for osteosarcoma of his radius. Pre-operative CT scan of chest had not shown any evidence of metastases. Twelve days postoperatively, a Hickman Catheter was inserted via the right externaljugular vein for the institution ofchemotherapy, and routine chest x-ray examination confirmed satisfactory position of the catheter but also revealed 30 percent left-sided pneumothorax. In retrospect, the patient recalled an episode ofleft pleuritic chest pain four days previously. Repeat chest x-ray 24 hours later showed deterioration of the left pneu-mothorax and also revealed a 30 percent right pneumothorax. Bilateral aspiration was performed using a 16 C needle and syringe, but within three days both pneumothoraces had recurred and a nodule was radiologically visible on the right pleural surface. CT scan now showed multiple pulmonary metastatic nodules. A 12 Ch " Argyle " chest drain with underwater seal was inserted on the right. When it was subsequently removed, the pneumothorax rapidly recurred, suggesting a bronchopleural fistula. Bilateral chest drains were then inserted under general anaesthesia and pleurodesis was achieved bilaterally by mntrapheural installation oftalc. He received chemotherapy with methotrexate, adriamycmn and cisplatinum. Four months later, CT scan shows regression of the pulmonary me-tastases, and there has been no further recurrence of the pneu-mothoraces. Osteosarcoma is the tumor most frequently complicated by pneumothoraces and these appear to be caused by rupture of necrotic pleural metastases. " As in our patient, a pneumothorax may be the first manifestation of metastatic disease.' It frequently occurs bilaterally and is recurrent, making it difficult to treat.2 In view of the good response of osteosarcoma to chemotherapy, it is particularly important that this complication is effectively treated and …