Pulmonary hemorrhage and hemopneumothorax following the administration of lenvatinib for lung metastasis from hepatocellular carcinoma

A 71-year-old man was started on 12 mg/day of lenvatinib for lung metastasis from hepatocellular carcinoma (HCC). The day after starting treatment, he developed hemoptysis, and a CT scan revealed a rupture of the left upper lobe metastasis, accompanied by pulmonary hemorrhage. Angiography was performed, and the responsible blood vessels, the bronchial artery and the left pulmonary artery (A1+2ab), were embolized. One week later, the patient developed a left tension pneumothorax. Despite thoracic drainage, air leakage and bloody drainage persisted. We decided to perform a left upper lobe resection to control the bleeding and air leakage. A 10-cm necrotic lesion was found in the left upper lobe, and the pleura between the lobes had ruptured, causing a hematoma to drain into the pleural cavity. We encountered a case of hemopneumothorax resulting from the rupture of lung metastases from HCC during treatment with lenvatinib.