what do some cardiac surgery patients and buffalo have in common?

a quick #FOAMed and tutorial

a patient few weeks post-sternotomy and prolonged vent-dependence suddenly develops tachypnea and hypoxemia with minimal air movement heard on auscultation

suspecting a pneumothorax you obtain a stat CXR and see this. woah!

*two* simultaneous pneumathoraces? what are the odds?

pretty rare to occur spontaneously. this is a phenomenon where an abnormal pleuro-pleural connection is created, essentially leaving the patient with a single pleural cavity. this can occur after mediastinal surgery

in this case, any inciting event that can lead to pneumothorax can lead to compression of both lungs in a pretty dramatic fashion and put the patient at risk of tension physiology

so what does this have to do with buffaloes? well, they're one of the few mammals that only have a single pleura

Indigenous hunters figured this out and targeted their spears at the lungs of buffalo to induce a tension pneumothorax

and thus we have a name: "buffalo lung"

the good news is that the physiology that makes this so dangerous makes the treatment that much easier

usually a single chest tube will resolve the entire thing

and eventually the pleural linings should heal and become two separate cavities once more

have you ever seen a buffalo pneumothorax before? share your stories below!

also, the more correct terminology is "bison" but I'm sticking with the accepted medical vernacular