Abstract Introduction “Buffalo lung,” or buffalo chest, is a rare condition characterized by a communication between the two pleural spaces. This phenomenon is named after the North American buffalo that has demonstrated this unique single pleural space physiology. Pneumothorax is a known, though infrequent, complication of pacemaker placement, almost always occurring on the ipsilateral side of the procedure. We present a case of buffalo lung in a patient with a history of CABG who developed bilateral pneumothoraces following a permanent pacemaker implantation. Case A 95-year-old male with a history of CABG in 2013 and sick sinus syndrome presented for an elective permanent pacemaker placement. The procedure was performed via left subclavian approach. Shortly after, the patient developed acute chest pain, hypoxemia, and hypotension. A chest radiograph revealed large right and left-sided pneumothoraces without tension physiology. It was suspected that intraprocedural vascular access on the left led to ipsilateral pneumothorax, with subsequent contralateral air tracking due to pleuro-pleural communication from his prior CABG. Given the patient’s hemodynamic instability and large bilateral pneumothoraces, he was treated urgently with bilateral chest tube thoracostomies. Following this, he had a rapid clinical improvement with resolution of his oxygen requirement and re-expansion of both lungs. The left chest tube was removed first, followed by the right chest tube the subsequent day without recurrence of pneumothorax. The pacemaker remained fully functional without complications. Novelty and Importance of Case This case highlights a rare but life-threatening complication of a common procedure in a patient with a history of cardiothoracic surgery. In one literature review from 2021, a total of 47 cases of buffalo chest were reported in humans, with the majority noted after cardiothoracic surgery. While unilateral pneumothorax is a recognized risk of pacemaker placement, the development of bilateral pneumothoraces should raise suspicion for an underlying “buffalo lung”. The presence of this anatomical variation has significant management implications. While in theory it has been suggested that a single chest tube can be sufficient to resolve bilateral pneumothoraces in stable patients, our case supports a more cautious approach. Due to the potential for complications such as tension pneumothorax if a single tube fails to adequately drain both pleural spaces, the placement of bilateral chest tubes was a prudent and effective strategy in this acutely ill patient. This case underscores the importance for physicians to be aware of “buffalo lung” physiology in post-cardiothoracic surgery patients to ensure prompt and appropriate management of pneumothorax. This abstract is funded by: None
Mahadevan et al. (Fri,) studied this question.