Spontaneous pneumotorax has been a very rare complication of pulmonary and tracheal tumors with an incidence of 0.03- 0.05% but has a considerable clinical importance.

Objective:

Our aim was to document the rare pneumothoracis due to the carcinoma located at the tracheobronchial tree and to emphasize clinical importance and possible modus operandi remains to be speculative.

Patients and methods:

In a series of 302 patients who admitted to our hospital between January 1994 and June 1998 with pneumothorax, 5 patients (0.16%) proved to have a tracheobronchial tumor were retrospectively reviewed. Three patients have ipsilateral, one patient has contralateral and the one has metachronously bilateral pneumothorax. A pneumothorax diagnosis was made using posteroanterior plain chest radiograph in all patients. As a initial treatment, tube thoracostomy and closed water-sealed thoracic drainage system were performed. Disclosure of the tumor was done by plain chest radiograph in four cases, computerized tomography of thorax in one case. Two patients were operated on and the tumors were resected en bloc. Latter three were evaluated to be inoperable since the tumor was extended stage small cell carcinoma in one case, cardiac failure in one and respiratory insufficiency in one case.

Results:

The patients with tracheobronchial tumor presented with pneumothorax have very limited resectability. Possible causes of pneumothorax could be 1) Direct pleural invasion of the tumor 2) alveolar rupture due to the obstructive hyperinflation caused by the almost totally obstructed airway by the tumor, 3) Alveolar rupture attributable to hyperinflation of the ipsilateral other lobes due to the tumoral collapse of the lung or 4) Other causes yet to be known.

Conclusions:

Pneumothorax is a rare complication of the tracheobronchial tumor and of clinical importance since it points out the advanced status of tumor. Tracheobronchial tumor must be kept in mind in the evaluation and treatment of pneumothorax patient who is a smoker and over 40 years.