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• W4304148474 abstract "SESSION TITLE: Uncommon Procedures and Procedure Complications Case PostersSESSION TYPE: Case Report PostersPRESENTED ON: 10/17/2022 12:15 pm - 01:15 pmINTRODUCTION: Transthoracic biopsy is a diagnostic tool commonly used for suspicious nodules or masses in the lung. As with any procedure, it carries benefits however it also carries risks. One of the risks classically associated with transthoracic biopsy is pneumothorax, however not all cases are what one might expect. Here we present a case where post-surgical changes in anatomy lead to an unusual presentation of a common complication.CASE PRESENTATION: A 70-year-old male with a past medical history of esophageal cancer status post robot-assisted transhiatal esophagectomy 6 months prior to presentation underwent a CT guided biopsy of left lower lobe nodules that were positive on PET scan. The patient underwent the procedure with 6 cores of the nodule taken in biopsy, but was seen during the procedure to develop a pneumothorax. When he was repositioned from the prone to supine position, imaging now showed a large right sided pneumothorax. An 8.5 French chest tube was placed on the right side by the Interventional Radiologist and the patient was sent to the ER for admission and chest tube management. The patient was asymptomatic in the hospital, and after 2 days both lungs remained re-expanded after clamping trial of the chest tube. The chest tube was discontinued and the patient was discharged home.DISCUSSION: A contralateral pneumothorax after a transthoracic biopsy is possible only if there is a connection between the normally separate pleural cavities. This is sometimes referred to as a buffalo chest” due to buffalo only having one pleural cavity for both lungs. Our patient's prior surgical history led to his atypical presentation. Typically, his thoracic cavity should have healed this far out from the esophagectomy, but CT imaging showed air traveling posterior to the esophagus, indicating there was a connection between his left and right pleural cavities. This allowed air to escape from his left lung during biopsy to migrate to the right pleural cavity.This was easily identified on CT chest, but may not have been as easily identified using other modalities. Ultrasound is becoming a more common diagnostic tool at the point of care, and using it to check for lung sliding is a common method to identify and rule out pneumothoraces. However, if this patient only had lung sliding checked over the left side where the biopsy occurred, the right sided collection of air would have gone undetected when he was repositioned. This is one of many reasons why it is taught to always check bilaterally when using ultrasound to assess for pneumothorax.CONCLUSIONS: Patients who have undergone surgeries with resulting changes to their thoracic anatomy, as our patient had with his esophagectomy, can often be at risk of different procedural complications than those with typical anatomy. It is important to consider these risks when discussing the safety of the procedure and when assessing for any complications.Reference #1: Blacha MMJ, Smesseim I, van der Lee I, van den Aardweg JG, Schultz MJ, Kik MLJ, van Sonsbeek L, de Bakker BS, Light RW. The Legend of the Buffalo Chest. Chest. 2021 Dec;160(6):2275-2282. doi: 10.1016/j.chest.2021.06.043. Epub 2021 Jun 30. PMID: 34216606; PMCID: PMC8692104.DISCLOSURES: No relevant relationships by Jesus PenabadSpeaker/Speaker's Bureau relationship with Bayer Please note: current Added 03/30/2022 by Paul Strachan, value=HonorariaSpeaker/Speaker's Bureau relationship with United Therapeutics Please note: more than 5 years Added 03/30/2022 by Paul Strachan, value=HonorariaSpeaker/Speaker's Bureau relationship with Gilead Please note: $1001 - $5000 by Paul Strachan, value=HonorariaRemoved 03/30/2022 by Paul StrachanSpeaker/Speaker's Bureau relationship with Genentech Please note: $5001 - $20000 by Paul Strachan, value=HonorariaRemoved 03/30/2022 by Paul StrachanSpeaker/Speaker's Bureau relationship with Boehringer Ingelhein Please note: More than 5 years Added 03/30/2022 by Paul Strachan, value=HonorariaStock Ownership relationship with Pfizer Please note: Purchased in 2000-2002 Added 03/30/2022 by Paul Strachan, value=nothing, I purchased stockSpeaker/Speaker's Bureau relationship with Portola Please note: $1001 - $5000 by Paul Strachan, value=HonorariaRemoved 03/30/2022 by Paul StrachanStock Ownership relationship with Portola Please note: $5001 - $20000 by Paul Strachan, value=nothing, I purchased stockRemoved 03/30/2022 by Paul StrachanStock Ownership relationship with La Jolla Pharmaceuticals Please note: Purchased a few years back Added 03/30/2022 by Paul Strachan, value=nothing, I purchased stockStock Ownership relationship with Seatle Genetics Please note: Purchased more than 5 years ago Added 03/30/2022 by Paul Strachan, value=nothing, I purchased stockPI relationship with United Therapeutics Please note: Current Added 03/30/2022 by Paul Strachan, value=Grant/Research SupportPI relationship with Actelion/Janssen Please note: Current Added 03/30/2022 by Paul Strachan, value=Grant/Research SupportPI for clinicial trial relationship with Roche Please note: Current Added 03/30/2022 by Paul Strachan, value=Grant/ResearchPI for clinicial trial relationship with Bellerophon Please note: Current Added 03/30/2022 by Paul Strachan, value=Grant/Research SupportSpeaker/Speaker's Bureau relationship with Actelion/Janssen Please note: Current Added 03/30/2022 by Paul Strachan, value=Honoraria SESSION TITLE: Uncommon Procedures and Procedure Complications Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Transthoracic biopsy is a diagnostic tool commonly used for suspicious nodules or masses in the lung. As with any procedure, it carries benefits however it also carries risks. One of the risks classically associated with transthoracic biopsy is pneumothorax, however not all cases are what one might expect. Here we present a case where post-surgical changes in anatomy lead to an unusual presentation of a common complication. CASE PRESENTATION: A 70-year-old male with a past medical history of esophageal cancer status post robot-assisted transhiatal esophagectomy 6 months prior to presentation underwent a CT guided biopsy of left lower lobe nodules that were positive on PET scan. The patient underwent the procedure with 6 cores of the nodule taken in biopsy, but was seen during the procedure to develop a pneumothorax. When he was repositioned from the prone to supine position, imaging now showed a large right sided pneumothorax. An 8.5 French chest tube was placed on the right side by the Interventional Radiologist and the patient was sent to the ER for admission and chest tube management. The patient was asymptomatic in the hospital, and after 2 days both lungs remained re-expanded after clamping trial of the chest tube. The chest tube was discontinued and the patient was discharged home. DISCUSSION: A contralateral pneumothorax after a transthoracic biopsy is possible only if there is a connection between the normally separate pleural cavities. This is sometimes referred to as a buffalo chest” due to buffalo only having one pleural cavity for both lungs. Our patient's prior surgical history led to his atypical presentation. Typically, his thoracic cavity should have healed this far out from the esophagectomy, but CT imaging showed air traveling posterior to the esophagus, indicating there was a connection between his left and right pleural cavities. This allowed air to escape from his left lung during biopsy to migrate to the right pleural cavity. This was easily identified on CT chest, but may not have been as easily identified using other modalities. Ultrasound is becoming a more common diagnostic tool at the point of care, and using it to check for lung sliding is a common method to identify and rule out pneumothoraces. However, if this patient only had lung sliding checked over the left side where the biopsy occurred, the right sided collection of air would have gone undetected when he was repositioned. This is one of many reasons why it is taught to always check bilaterally when using ultrasound to assess for pneumothorax. CONCLUSIONS: Patients who have undergone surgeries with resulting changes to their thoracic anatomy, as our patient had with his esophagectomy, can often be at risk of different procedural complications than those with typical anatomy. It is important to consider these risks when discussing the safety of the procedure and when assessing for any complications. Reference #1: Blacha MMJ, Smesseim I, van der Lee I, van den Aardweg JG, Schultz MJ, Kik MLJ, van Sonsbeek L, de Bakker BS, Light RW. The Legend of the Buffalo Chest. Chest. 2021 Dec;160(6):2275-2282. doi: 10.1016/j.chest.2021.06.043. Epub 2021 Jun 30. PMID: 34216606; PMCID: PMC8692104. DISCLOSURES: No relevant relationships by Jesus Penabad Speaker/Speaker's Bureau relationship with Bayer Please note: current Added 03/30/2022 by Paul Strachan, value=Honoraria Speaker/Speaker's Bureau relationship with United Therapeutics Please note: more than 5 years Added 03/30/2022 by Paul Strachan, value=Honoraria Speaker/Speaker's Bureau relationship with Gilead Please note: $1001 - $5000 by Paul Strachan, value=Honoraria Removed 03/30/2022 by Paul Strachan Speaker/Speaker's Bureau relationship with Genentech Please note: $5001 - $20000 by Paul Strachan, value=Honoraria Removed 03/30/2022 by Paul Strachan Speaker/Speaker's Bureau relationship with Boehringer Ingelhein Please note: More than 5 years Added 03/30/2022 by Paul Strachan, value=Honoraria Stock Ownership relationship with Pfizer Please note: Purchased in 2000-2002 Added 03/30/2022 by Paul Strachan, value=nothing, I purchased stock Speaker/Speaker's Bureau relationship with Portola Please note: $1001 - $5000 by Paul Strachan, value=Honoraria Removed 03/30/2022 by Paul Strachan Stock Ownership relationship with Portola Please note: $5001 - $20000 by Paul Strachan, value=nothing, I purchased stock Removed 03/30/2022 by Paul Strachan Stock Ownership relationship with La Jolla Pharmaceuticals Please note: Purchased a few years back Added 03/30/2022 by Paul Strachan, value=nothing, I purchased stock Stock Ownership relationship with Seatle Genetics Please note: Purchased more than 5 years ago Added 03/30/2022 by Paul Strachan, value=nothing, I purchased stock PI relationship with United Therapeutics Please note: Current Added 03/30/2022 by Paul Strachan, value=Grant/Research Support PI relationship with Actelion/Janssen Please note: Current Added 03/30/2022 by Paul Strachan, value=Grant/Research Support PI for clinicial trial relationship with Roche Please note: Current Added 03/30/2022 by Paul Strachan, value=Grant/Research PI for clinicial trial relationship with Bellerophon Please note: Current Added 03/30/2022 by Paul Strachan, value=Grant/Research Support Speaker/Speaker's Bureau relationship with Actelion/Janssen Please note: Current Added 03/30/2022 by Paul Strachan, value=Honoraria" @default.
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• W4304148474 title "BIOPSY ON THE LEFT, PNEUMOTHORAX ON THE RIGHT: IS IT A HUMAN BUFFALO LUNG?" @default.
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