{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T10:26:05Z","timestamp":1780050365089,"version":"3.53.1"},"reference-count":5,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,10,22]],"date-time":"2020-10-22T00:00:00Z","timestamp":1603324800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,10,22]],"date-time":"2020-10-22T00:00:00Z","timestamp":1603324800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["surg case rep"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Pulmonary metastasis of scalp angiosarcoma (SA) is a rare, but life-threatening disease, challenging to diagnose and manage. We report two cases of pneumothorax and hemothorax with pathologically proven metastasis of SA in the parietal pleura, which was not predictable from images and difficult to manage.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Patient A<\/jats:title>\n<jats:p>A 73-year-old man with SA underwent chemoradiotherapy and surgical resection for primary skin lesion, was sent to our department to treat right empyema, which was developed during chest tube drainage for pneumothorax. Computed tomography (CT) showed multiple bullous lesions. We performed repetitive video-assisted thoracoscopic surgery (VATS) for the debridement and hemostasis; however, hemothorax was uncontrollable. The repeated cytology of pleural effusion showed no malignancy. We eventually performed fenestration and metastatic SA was pathologically diagnosed by the biopsy of parietal pleura. The patient developed respiratory failure and uncontrolled anemia, which were fatal.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Patient B<\/jats:title>\n<jats:p>A 71-year-old man with SA previously treated with chemoradiotherapy was referred to our department for left pneumothorax. CT showed multiple bullous lesions at apex without any changes at parietal pleura. VATS was performed and the apex bullous lesion with air leakage was resected. The parietal pleura showed several dark-red spots and the biopsy was undertaken. The pathological diagnosis was a metastasis of SA along with visceral pleura and parietal pleura. The patient then developed right pneumothorax and left hemopneumothorax. Bilateral pleurodesis was ineffective and the patient died due to deteriorating general condition.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>In patients with a history of SA who develop pneumothorax and hemothorax, metastatic SA to visceral and parietal pleura should be always considered. Surgical biopsy, not cytology, is needed for pathological diagnosis. Lesions in the parietal pleura prior to hemothorax were thoracoscopically observed in one case. Surgeons must recognize that conventional surgical intervention or pleurodesis will have unsatisfactory results.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s40792-020-01001-w","type":"journal-article","created":{"date-parts":[[2020,10,22]],"date-time":"2020-10-22T14:03:00Z","timestamp":1603375380000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Refractory pneumothorax and hemothorax associated with metastatic scalp angiosarcoma"],"prefix":"10.1186","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4210-1884","authenticated-orcid":false,"given":"Masahide","family":"Isowa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satona","family":"Tanaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryo","family":"Nakanobo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshito","family":"Yamada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Date","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,10,22]]},"reference":[{"key":"1001_CR1","doi-asserted-by":"publisher","first-page":"e77","DOI":"10.1016\/j.athoracsur.2012.02.030","volume":"94","author":"KK Somasekharan Nair","year":"2012","unstructured":"Somasekharan Nair KK, Zabell AS, Vo KL, Shaikh MA. Pneumothorax: a classical presentation of metastatic scalp angiosarcoma. Ann Thorac Surg. 2012;94:e77\u20138.","journal-title":"Ann Thorac Surg"},{"key":"1001_CR2","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1007\/BF00750735","volume":"412","author":"M Kitagawa","year":"1987","unstructured":"Kitagawa M, Tanaka I, Takemura T, Matsubara O, Kasuga T. Angiosarcoma of the scalp: report of two cases with fatal pulmonary complications and a review of Japanese autopsy registry data. Virchows Arch A Pathol Anat Histopathol. 1987;412:83\u20137.","journal-title":"Virchows Arch A Pathol Anat Histopathol"},{"key":"1001_CR3","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.ijscr.2017.02.026","volume":"34","author":"YS Cheng","year":"2017","unstructured":"Cheng YS, Chen TM, Tsai WC, Huang TW. Pulmonary metastatic angiosarcoma from scalp with fatal complication: a case report. Int J Surg Case Rep. 2017;34:36\u20139.","journal-title":"Int J Surg Case Rep"},{"key":"1001_CR4","doi-asserted-by":"publisher","first-page":"1671","DOI":"10.2214\/ajr.180.6.1801671","volume":"180","author":"U Tateishi","year":"2003","unstructured":"Tateishi U, Hasegawa T, Kusumoto M, Yamazaki N, Iinuma G, Muramatsu Y, et al. Metastatic angiosarcoma of the lung: spectrum of CT findings. AJR Am J Roentgenol. 2003;180:1671\u20134.","journal-title":"AJR Am J Roentgenol"},{"key":"1001_CR5","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1016\/j.resinv.2016.04.005","volume":"54","author":"K Nohara","year":"2016","unstructured":"Nohara K, Takada K, Kojima E, Ninomiya K, Miyamatsu S, Shimizu T, et al. A propensity score-matched comparison of the efficacies of OK-432 and talc slurry for pleurodesis for malignant pleural effusion induced by lung adenocarcinoma. Respir Investig. 2016;54:341\u20136.","journal-title":"Respir Investig"}],"container-title":["Surgical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40792-020-01001-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40792-020-01001-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40792-020-01001-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,21]],"date-time":"2021-10-21T23:34:10Z","timestamp":1634859250000},"score":1,"resource":{"primary":{"URL":"https:\/\/surgicalcasereports.springeropen.com\/articles\/10.1186\/s40792-020-01001-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,22]]},"references-count":5,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["1001"],"URL":"https:\/\/doi.org\/10.1186\/s40792-020-01001-w","relation":{},"ISSN":["2198-7793"],"issn-type":[{"value":"2198-7793","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,22]]},"assertion":[{"value":"11 August 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 September 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 October 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The privacy of the patient was considered, and the manuscript does not include any identifying information.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Informed consent for publication of the patient\u2019s clinical data and the accompanying images was obtained from the patient.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"272"}}