SPILLED MILK: BUFFALO CHEST WITH BILATERAL CHYLOTHORAX

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: The term "buffalo chest" is used to define a single pleural space with no anatomic separation of the two hemithoraces, seen in an American buffalo or bison. There have been less than ten cases reported where spontaneous bilateral pneumothorax was suspected due interpleural communication. connection associated major invasive thoracic procedures such as esophagectomy, cardiothoracic surgery, pacemaker and central venous catheter placements. We present rare case simultaneous chylothorax fashioned by CASE PRESENTATION: A 45-year-old male chronic smoker past medical history esophagitis presented one week cough reflux. He otherwise denied fevers, odynophagia, chest pain, weight loss early satiety. hypoxic on admission requiring 2 L oxygen supplementation. Physical exam revealed decreased breath sounds left lower lung base. Chest radiograph showed minimal atelectasis at CT large sliding hiatal hernia distention esophagus centrilobular nodules right middle lobe lobes. presumptive diagnosis aspiration pneumonia likely secondary hernia. Thus, he underwent laparoscopic para-esophageal repair EGD. Two days later, developed acute respiratory failure intubated. concerning for new effusions. Within hours, ultrasound guided thoracentesis draining four liters opaque, pink, non-purulent fluid (figure 1). Left drained only five mL. Pleural pH 7.48, elevated triglycerides (600 mg/dL) low cholesterol (50 indicating chylothorax. had tubes placed bowel rest. Decision made evaluate duct injury setting recent taken video-assisted thoracoscopic surgery ligation talc pleurodesis. It that there communication from cavity into mediastinal area dissection. This explained resolution right-sided thoracentesis. Patient extubated thereafter discharged. DISCUSSION: report documents completely resolved sided phenomenon formed during suggesting chest. CONCLUSIONS: Recognition syndrome life-threatening complication important iatrogenic injuries surgeries. Prompt can be achieved REFERENCE #1: Eguchi T, Hamanaka K, Kobayashi N, et al. Occurrence pleuro-pleural Ann Thorac Surg 2011;92:1124-6 Hartin DJ, Kendall R, Boyle AA, month: Buffalo chest: pneumothoraces pleuropleural Emerg Med J 2006;23:483-6 #2: Männer J, Jakob C, Steding G, Horseshoe lung: variant—"inverted" horseshoe lung--with embryological reflections formal pathogenesis lungs. Anat 2001;183:261-5 #3: Rali AS, Manyam H. Bilateral Pneumothoraces Following BiV ICD Placement: Syndrome. Am Rep. 2015;16:703–6. DISCLOSURES: No relevant relationships Jaclyn Boozalis, source=Web Response Kevin Ferriter, Paul Harford, Kanza Muzaffar, Nisha Soneji, source=Admin input