PMC5140860_01
a, b: Computed tomography findings suggested multiple lung metastases in both lung fields (arrow).
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A biopsy showed well-differentiated adenocarcinoma, and computed tomography (CT) findings suggested multiple lung metastases in both lung fields (Fig. 1); therefore, colon cancer cStage IV A [according to the Unio Internationalis Contra Cancrum (UICC)] was diagnosed.
a, b: After bevacizumab+XELOX (capecitabine, oxaliplatin) therapy was started, cavitation within the pulmonary metastatic lesions was observed; the cavitation was considered to be caused by bevacizumab (arrow).
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After bevacizumab (BV) (7.5 mg/kg on day1) + XELOX (capecitabine, oxaliplatin) therapy was started, cavitation within the pulmonary metastatic lesions was found (Fig. 2); the cavitation was considered to be caused by BV. After 8 courses of this regimen, lung metastases showed a transition to progressive disease.
a-c: After 8 courses of bevacizumab+XELOX (capecitabine, oxaliplatin) therapy, lung metastases showed a transition to progressive disease. Thereafter, bevacizumab+FOLFIRI (irinotecan, l-leucovorin, 5-fluorouracil) therapy was started. On day 4 of course 5, the patient experienced pain on the left side of his chest and was admitted to our hospital. CT showed infiltrative shadows with cavities in the left S1+2 through S4 lung field. Although inflammatory changes were considered, because the blood test results for inflammatory markers were unremarkable and infection was ruled out, we speculated that a rupture of pulmonary metastatic lesions occurred, leading to bleeding.
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CT showed infiltrative shadows with cavities in the left S1+2 through S4 lung field (Fig. 3).
a, b: Two days after hospitalization, chest radiography as well as CT showed pneumothorax. In addition, the infiltrative shadows that were observed from the S1+2 through S4 field appeared as massive bullae, around which dense infiltrative shadows that extended up to the pleura were observed. The rapid alteration in the left lung was presumably caused by rupture and bleeding that occurred from a part of the pulmonary metastatic lesions. Furthermore, the airspace expanded in the form of a check valve to generate the bullae, which infiltrated into the pleura and led to the formation of the pneumothorax.
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In addition, the infiltrative shadows that were observed from the S1+2 through S4 field appeared as massive bullae, around which dense infiltrative shadows that extended up to the pleura were observed (Fig. 4).