Fig. 3

Spontaneous pneumothorax as the first sign of a primary lung carcinoma in an 87-year-old woman who presented at the emergency department with thoracic pain and severe respiratory distress. a Supine anteroposterior chest radiograph clearly depicts a right-sided pneumothorax with complete collapse of the right lung. The visceral pleural edge is observed clearly as a very thin, sharp line (yellow arrows) with the absence of vascular marking beyond the pleural line. b Axial contrast-enhanced chest CT in lung window setting shows a large thin-walled cystic lesion (asterisk) with peripheral solid nodular component (yellow arrow) in the right upper lobe as the underlying cause of the pneumothorax. Also, note the extensive subcutaneous emphysema in the right chest wall. Histopathological diagnosis of adenocarcinoma (type “lung cancer associated with cystic airspaces”) was made after lobectomy