Medical Image of the Month: Buffalo Chest Identified at the Time of Lung Nodule Biopsy

• Main Authors: Belone P, Lee J, Larson MC
• Format: Article
• Language: English
• Published: Arizona Thoracic Society 2020-11-01
• Series: Southwest Journal of Pulmonary and Critical Care
• Subjects: buffalo chest; pneumothorax; pneumothoraces; bilateral; treatment; unilateral chest tube; pleural-pleural communication
• Online Access: https://www.swjpcc.com/imaging/2020/11/2/medical-image-of-the-month-buffalo-chest-identified-at-the-t.html

No abstract available. Manuscript truncated after 150 words. A gentleman in his late 50s with a past medical history of squamous cell carcinoma at the base of the tongue had numerous slowly-growing pneumocyst-like lesions despite clinical remission status post surgery and chemoradiation. Biopsy of one of these lesions was recommended by a multidisciplinary tumor board. An outpatient pre-procedural supine chest CT revealed a right pneumothorax above the lesion targeted for biopsy. A subsequent pre-procedural right lateral decubitus chest CT three weeks later demonstrated a left-sided pneumothorax, raising concern for buffalo chest. (A less likely possibility would be spontaneous resolution of the right pneumothorax and development of a new left pneumothorax in the less than 4-week interval.) Intraprocedural imaging continued to demonstrate the left-sided pneumothorax. A biopsy touch preparation of the first sample obtained did not demonstrate malignancy. Therefore, an attempt was made at obtaining another sample. However, the patient developed a brief but forceful coughing fit, resulting in …