Radiation and Bilateral Spontaneous Pneumothoraces
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Primary pneumothorax is an uncommon lung disease that can disrupt respiration in an otherwise healthy individual. It is most commonly caused by rupture of a sub-pleural emphysematous bleb typically located at the apex of the lung. This rupture allows for air from the lung to move into the pleural space and compress the lung. Secondary pneumothorax occurs due to the presence of underlying lung pathology such as chronic obstructive pulmonary disease but other causes include but are not limited to an infectious process or malignancy. Much less frequently, spontaneous pneumothorax occurs as a complication of thoracic radiotherapy. In this report, we further illustrate an unusual finding of post-radiation-induced bilateral pneumothorax after the treatment of angiosarcoma.

Case Report
An 85-year-old Caucasian female nonsmoker with a past medical history significant for angiosarcoma presented to emergency department with a 2-week long history of progressively worsening shortness of breath. The patient’s angiosarcoma originated from the scalp and had extension into the face with metastasis to the lung. The patient previously had surgery to remove the angiosarcoma in the scalp and had reconstruction done. The patient was further treated with radiotherapy for the metastasis to the lung, with the latest treatment administered 2 weeks prior to her presenting to the emergency department. She had received a total of 12 MeV electrons delivered to the site with a dose of 57.2 Gy fractions in 20 fractions over a several week interval. She reported that her shortness of breath had been getting progressively worse and was associated with a productive cough. She denied orthopnea, paroxysmal nocturnal dyspnea, chest pain, palpitations, fevers, chills, or changes in weight.....