Recurrent spontaneous pneumothorax complicating osteosarcoma pulmonary metastasis

We report the case of a 15-year-old girl with osteosarcoma in the left distal femur who developed a recurrent spontaneous pneumothorax. The patient was treated by neoadjuvant chemotherapy followed by surgery (limb-sparing surgical procedure with insertion of a knee prosthesis) and then adjuvant chemotherapy. The initial extension assessment was normal. No pulmonary metastasis was found. The chest tomography performed at the end of treatment (8 months after surgery) revealed two peripheral pulmonary nodules not seen on the chest X-ray. Palliative chemotherapy was given, the thoracic tomography after four chemotherapy courses showed a progress of the pulmonary metastasis and on the right more abundant bilateral pneumothorax which had recurred two months after thoracic draining. Thoracoscopy showed no pleural lesions.