Development of Bilateral Pneumothoraces Secondary to a Communicating Pleural Cavity: A Case Report

Double-lung transplant recipients may have an iatrogenic communicating pleural space (known as “buffalo chest”) postoperatively, placing them at risk for uncommon but potentially life-threatening complications. We report the case of an 80-year-old man with a history of bilateral lung transplantation who presented with right scapular pain after a low-level mechanical fall, found to have bilateral pneumothoraces on computed tomography. Identification of a communicating pleural cavity on imaging prompted management with a single right-sided 14-French pigtail catheter chest tube placed percutaneously under ultrasound guidance. Successful, uncomplicated bilateral lung re-expansion was achieved, and the patient was discharged following chest tube removal. Subsequent imaging revealed a new pulmonary nodule confirmed on histopathology to represent metastatic pleomorphic dermal sarcoma. This case demonstrates the identification of a shared pleural space in double-lung transplant recipients to guide appropriate intervention with single chest tube decompression and highlights the consideration of malignancy surveillance following unexplained pneumothorax in immunocompromised transplant recipients.