Bilateral dissemination of malignant pleural mesothelioma via iatrogenic buffalo chest: a rare route of disease progression

Our plain-English summary of Bilateral dissemination of malignant pleural mesothelioma via iatrogenic buffalo chest: a rare route of disease progression, by K. Ikezoe, E. Tanaka, K. Tanizawa, et al (General Thoracic and Cardiovascular Surgery, 2012).

The study

• Authors: K. Ikezoe, E. Tanaka, K. Tanizawa, S. Hashimoto, T. Shindo, S. Noma, Y. Kobashi, Y. Taguchi
• Journal: General Thoracic and Cardiovascular Surgery
• Published: 2012;60(9):595-8
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Buffalo chest refers to the pleuro-pleural communication that results in a single pleural cavity. Iatrogenic buffalo chest can occur following heart or heart-lung transplantation and other major thoracic surgeries. We present the case of malignant pleural mesothelioma in which iatrogenic buffalo chest after extended thymectomy caused bilateral pneumothoraces and contralateral dissemination of the disease. The free communication between bilateral pleural cavities had facilitated the rapid progression of tumor and the consequent bilateral malignant pleural effusions had made the management of disease much more difficult, leading to the early fatal outcome. To our knowledge, this is the first case of buffalo chest that was associated with bilateral malignant pleural effusions.

In plain English

This case report described one 75-year-old Japanese man with malignant pleural mesothelioma. He had worked in an ironworks for about 40 years, and the authors wrote that he may have been exposed to asbestos dust. Thirteen months earlier he had undergone extended thymectomy through median sternotomy for myasthenia gravis and had been treated with corticosteroids. He was admitted with breathlessness and fluid at the same level in both sides of the chest. Fluid samples showed no malignant cells. While a right chest tube was being prepared, both lungs collapsed (bilateral pneumothoraces). A CT scan and a dye test showed that the two pleural cavities were connected, a condition called buffalo chest, which the authors linked to the earlier surgery. Thoracoscopy of the left chest found plaques and tumors, and the tumor was mixed-type mesothelioma. At a later right-side operation, mesothelioma had spread to the right pleural cavity (stage IV). He chose supportive care and died of respiratory failure one month later. The authors concluded that iatrogenic buffalo chest can cause bilateral pneumothoraces and also bilateral malignant pleural effusions.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One 75-year-old Japanese man admitted to Tenri Hospital, Japan, with a 1-month history of breathlessness. He had had extended thymectomy by median sternotomy for myasthenia gravis 13 months earlier.
• Exposure: About 40 years of work in an ironworks with possible (not confirmed) asbestos dust exposure. Fiber type not reported. The case centers on a surgical complication: a pleuro-pleural connection ('buffalo chest') after extended thymectomy by median sternotomy.
• Main results:
  • On admission, fluid samples from both pleural cavities were exudates with no malignant cells, bacteria, or mycobacteria found.
  • After a local anesthetic injection in the right chest, the patient developed bilateral pneumothoraces. The authors attributed this to an accidental puncture of the right lung. Tension pneumothoraces were found when chest tubes were inserted.
  • A CT scan showed a possible connection between the pleural cavities but no tumor or pleural plaques.
  • Methylene blue put into the left pleural cavity drained out through the right chest tube.
  • Thoracoscopy of the left chest showed plaques and tumors on the parietal pleura. The tumor was mixed-type mesothelioma, and the pleuro-pleural connection was confirmed in the anteroinferior mediastinum.
  • At a right-side operation one month after left pleurodesis, mesothelioma had spread into the right pleural cavity (pT4N0M0, stage IV by IMIG staging).
  • The patient chose best supportive care and died of respiratory failure 1 month later.
• The authors' conclusion: The authors concluded that iatrogenic buffalo chest can cause not only bilateral pneumothoraces but also bilateral malignant pleural effusions. They wrote that the connection may help malignant disease spread to the other side early and make management more difficult.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Bilateral, Pleural Mesothelioma, Disease Progression, Pleural Cavity, Lung Transplant, Pleural Effusion.

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