The legend of the buffalo chest

Background The “buffalo chest” is a condition in which a simultaneous bilateral pneumothorax occurs due to a communication of both pleural cavities caused by an iatrogenic or idiopathic fenestration of the mediastinum. This rare condition is known by many clinicians because of a particular anecdote which stated that Native Americans could kill a North American bison with a single arrow in the chest by creating a simultaneous bilateral pneumothorax, due to the animal’s peculiar anatomy in which there is one contiguous pleural space due to an incomplete mediastinum. Research Question What evidence is there for the existence of buffalo chest? Study Design and Methods The term “buffalo chest” and its anecdote were first mentioned in a ‘‘personal communication’’ by a veterinarian in the Annals of Surgery in 1984. A mixed method research was performed on buffalo chest and its etiology. A total of 47 cases of buffalo chest were identified in humans. Results This study found that all authors were referring to the article from 1984 or to each other. Evidence was found for interpleural communications in other mammal species, but no literature on the anatomy of the mediastinum of the bison was found. The main reason for this research was fact-checking the origin of the anecdote and search for evidence for the existence of buffalo chest. Autopsies were performed on eight bison, and four indeed were found to have had interpleural communications. Interpretation We hypothesize that humans can also have interpleural fenestrations, which can be diagnosed when a pneumothorax occurs

Focal 18F-FDG uptake predicts progression of pre-invasive squamous bronchial lesions to invasive cancers

Introduction: Pre-invasive squamous lesions of the central airways can progress into invasive lung cancers. Identifying these high-risk patients could enable detection of invasive lung cancers at an early stage. In this study, we investigated the value of 18F-fluorodeoxyglucose ( 18F-FDG) positron emission tomography (PET) scans in predicting progression in patients with pre-invasive squamous endobronchial lesions. Methods: In this retrospective study, patients with pre-invasive endobronchial lesions, who underwent an 18F-FDG PET scan at the VU University Medical Center Amsterdam, between January 2000 and December 2016, were included. Autofluorescence bronchoscopy (AFB) was used for tissue sampling and was repeated every 3 months. The minimum and median follow-up was 3 and 46.5 months. Study endpoints were the occurrence of biopsy proven invasive carcinoma, time-to-progression and overall survival (OS). Results: A total number of 40 of 225 patients met the inclusion criteria of which 17 (42.5%) patients had a positive baseline 18F-FDG PET scan. A total of 13 of 17 (76.5%) developed invasive lung carcinoma during follow-up, with a median time to progression of 5.0 months (range, 3.0–25.0). In 23 (57.5%) patients with a negative 18F-FDG PET scan at baseline, 6 (26%) developed lung cancer, with a median time to progression of 34.0 months (range, 14.0–42.0 months, p < 0.002). With a median OS of 56.0 months (range, 9.0–60.0 months) versus 49.0 months (range, 6.0–60.0 months) (p = 0.876) for the  18F-FDG PET positive and negative groups, respectively. Conclusions: Patients with pre-invasive endobronchial squamous lesions and a positive baseline 18F-FDG PET scan were at high-risk for developing lung carcinoma, highlighting that this patient group requires early radical treatment

Focal 18F‐FDG uptake predicts progression of pre‐invasive squamous bronchial lesions to invasive cancers

Abstract Introduction Pre‐invasive squamous lesions of the central airways can progress into invasive lung cancers. Identifying these high‐risk patients could enable detection of invasive lung cancers at an early stage. In this study, we investigated the value of 18F‐fluorodeoxyglucose (18F‐FDG) positron emission tomography (PET) scans in predicting progression in patients with pre‐invasive squamous endobronchial lesions. Methods In this retrospective study, patients with pre‐invasive endobronchial lesions, who underwent an 18F‐FDG PET scan at the VU University Medical Center Amsterdam, between January 2000 and December 2016, were included. Autofluorescence bronchoscopy (AFB) was used for tissue sampling and was repeated every 3 months. The minimum and median follow‐up was 3 and 46.5 months. Study endpoints were the occurrence of biopsy proven invasive carcinoma, time‐to‐progression and overall survival (OS). Results A total number of 40 of 225 patients met the inclusion criteria of which 17 (42.5%) patients had a positive baseline 18F‐FDG PET scan. A total of 13 of 17 (76.5%) developed invasive lung carcinoma during follow‐up, with a median time to progression of 5.0 months (range, 3.0–25.0). In 23 (57.5%) patients with a negative 18F‐FDG PET scan at baseline, 6 (26%) developed lung cancer, with a median time to progression of 34.0 months (range, 14.0–42.0 months, p < 0.002). With a median OS of 56.0 months (range, 9.0–60.0 months) versus 49.0 months (range, 6.0–60.0 months) (p = 0.876) for the 18F‐FDG PET positive and negative groups, respectively. Conclusions Patients with pre‐invasive endobronchial squamous lesions and a positive baseline 18F‐FDG PET scan were at high‐risk for developing lung carcinoma, highlighting that this patient group requires early radical treatment

The Legend of the Buffalo Chest

BACKGROUND: The "buffalo chest" is a condition in which a simultaneous bilateral pneumothorax occurs due to a communication of both pleural cavities caused by an iatrogenic or idiopathic fenestration of the mediastinum. This rare condition is known by many clinicians because of a particular anecdote which stated that Native Americans could kill a North American bison with a single arrow in the chest by creating a simultaneous bilateral pneumothorax, due to the animal's peculiar anatomy in which there is one contiguous pleural space due to an incomplete mediastinum. RESEARCH QUESTION: What evidence is there for the existence of buffalo chest? STUDY DESIGN AND METHODS: The term "buffalo chest" and its anecdote were first mentioned in a ''personal communication'' by a veterinarian in the Annals of Surgery in 1984. A mixed method research was performed on buffalo chest and its etiology. A total of 47 cases of buffalo chest were identified in humans. RESULTS: This study found that all authors were referring to the article from 1984 or to each other. Evidence was found for interpleural communications in other mammal species, but no literature on the anatomy of the mediastinum of the bison was found. The main reason for this research was fact-checking the origin of the anecdote and search for evidence for the existence of buffalo chest. Autopsies were performed on eight bison, and four indeed were found to have had interpleural communications. INTERPRETATION: We hypothesize that humans can also have interpleural fenestrations, which can be diagnosed when a pneumothorax occurs

The Legend of the Buffalo Chest

BACKGROUND: The "buffalo chest" is a condition in which a simultaneous bilateral pneumothorax occurs due to a communication of both pleural cavities caused by an iatrogenic or idiopathic fenestration of the mediastinum. This rare condition is known by many clinicians because of a particular anecdote which stated that Native Americans could kill a North American bison with a single arrow in the chest by creating a simultaneous bilateral pneumothorax, due to the animal's peculiar anatomy in which there is one contiguous pleural space due to an incomplete mediastinum. RESEARCH QUESTION: What evidence is there for the existence of buffalo chest? STUDY DESIGN AND METHODS: The term "buffalo chest" and its anecdote were first mentioned in a ''personal communication'' by a veterinarian in the Annals of Surgery in 1984. A mixed method research was performed on buffalo chest and its etiology. A total of 47 cases of buffalo chest were identified in humans. RESULTS: This study found that all authors were referring to the article from 1984 or to each other. Evidence was found for interpleural communications in other mammal species, but no literature on the anatomy of the mediastinum of the bison was found. The main reason for this research was fact-checking the origin of the anecdote and search for evidence for the existence of buffalo chest. Autopsies were performed on eight bison, and four indeed were found to have had interpleural communications. INTERPRETATION: We hypothesize that humans can also have interpleural fenestrations, which can be diagnosed when a pneumothorax occurs