Buffalo pneumothorax - post-operative

Case contributed by Assoc Prof Craig Hacking

Presentation

Sudden severe dyspnea post pleural catheter insertion, for left pleural effusion day 4 post thymectomy. The patient was cold, clammy and tachycardic.

Patient Data

Age: 40 years
Gender: Male

Left pleural pigtail catheter appears appropriately positioned. Bilateral hydropneumothoraces and partial collapse of the lungs. No clear mediastinal shift although there may be competing shift. Sternotomy wires and mediastinal clips from recent thymectomy.

Post op CXR 2 days earlier

X-ray

Bilateral pleural effusions, left greater than right. Sternotomy wires and mediastinal clips from recent thymectomy.

Case Discussion

Bilateral pneumothoraces due to an abnormal (anomalous or iatrogenic) communication between the two pleural cavities is termed a buffalo pneumothorax as the buffalo classically has a single pleural cavity.

The patient had known myasthenia gravis and the thymectomy confirmed thymoma.

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