An 83-year-old man with bilateral spontaneous pneumothoraces and multiple cysts.

An 83-year-old man was transferred to our medical center with bilateral pneumothoraces. A biopsy of a nonhealing scalp lesion was done 4 weeks previously, and the specimen showed high-grade angiosarcoma. During the subsequent staging evaluation a week later, he was found to have asymptomatic bilateral pneumothoraces and multiple pulmonary cysts that were not metabolically active on 18 F-fluorodeoxyglucose (FDG)-PET scan. These findings were initially believed to be secondary to emphysema, and because of his absence of symptoms, the patient was sent home without intervention. However, several days later he developed a nonproductive cough with pleuritic chest pain and went to an outside ED. A chest radiograph again showed bilateral pneumothoraces, which resulted in placement of bilateral chest tubes with the subsequent transfer. His medical history was otherwise only remarkable for benign prostatic hypertrophy and cataracts. He admitted to smoking cigarettes remotely but denied fever, chills, leg swelling, palpitations, and syncope. He denied relevant occupational exposures, including asbestos.