Two Lungs, One Pleural Space, Managing Buffalo Chest Syndrome with Bilateral Drainage Following Computed Tomography-guided Lung Biopsy, A Case Report

Buffalo chest syndrome is a rare condition describing simultaneous bilateral pneumothoraces due to pleuropleural communication, with fewer than 50 reported cases. We describe a 70-year-old with prior esophagectomy/thoracotomy, who developed symptomatic bilateral pneumothoraces immediately after computed tomography-guided biopsy of a single lung lesion. This prompted insertion of bilateral 14-French pleural drains, achieving immediate clinical stability and full radiological resolution within 24 hours, compared with 2 to 5 days reported with single-drain management in existing literature. This single case highlights the potential role of early bilateral pleural drainage in buffalo chest syndrome, suggesting the potential of more rapid clinical and radiological resolution compared with previously reported single-drain approaches in symptomatic patients.