Bilateral pneumothorax after pacemaker placement "Buffalo chest"

Bilateral pneumothoraces following unilateral subclavian vein cannulation is a rare complication. It is usually associated with an intrapleural communication which can be congenital or formed following cardiothoracic and mediastinal surgeries, or trauma. The term Buffalo chest was used to define a single chest cavity with no anatomic separation of the two hemithoraces. It is called Buffalo chest because this unique chest anatomy of the American buffalo, or bison, helped hunters to kill them with a single arrow to the chest because the resultant pneumothorax could collapse both lungs. In distinction, the pleural cavities in humans are entirely separated. We describe an 83-year-old female without prior history of cardiothoracic surgery, trauma or lung disease, who underwent dual chamber pacemaker placement using a left subclavian vein access and developed bilateral pneumothoraces following the procedure. The bilateral pneumothoraces were completely resolved with single left-sided thoracostomy tube placement suggesting the patient had "Buffalo chest".