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”.

Patient: Female, 63Final Diagnosis: Pneumocystis jirovici pneumoniaSymptoms: CoughMedication: —Clinical Procedure: BronchoscopySpecialty: Infectious DiseasesObjective:Challenging differential diagnosisBackground:Pneumocystis jiroveci pneumonia (PCP) – formerly known as Pneumocyctis carinii pneumonia – with newly diagnosed AIDS is an uncommon presentation in people over 50 years of age. A high level of suspicion is required for this diagnosis when an elderly patient with pneumonia is not responding to broad-spectrum antibiotic treatment.Case Report:We describe the case of a 63-year-old woman who presented with dyspnea, cough, and significant hypoxemia requiring high-flow oxygen supplement with bilateral lung infiltrates, treated with broad-spectrum antibiotics for a presumed diagnosis of pneumonia. The patient demonstrated slow clinical improvement. A diagnostic bronchoscopy with transbronchial biopsy was done, which revealed unexpected findings of Pneumocystis organisms on GMS stain. The patient tested positive for HIV and was found to have a low CD4 of 47. She was treated for Pneumocystis jiroveci pneumonia (PCP) and recovered accordingly.Conclusions:It is essential to remember that HIV and the associated opportunistic infections can be very easily overlooked in the elderly. Taking a sexual history can be challenging, especially in the older population, but it should be performed. Keep in mind that aged people can get infected with HIV at an earlier stage in life and remain in latent phase for up to 15 years without specific symptoms.

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The most common provoking factors for chronic Obstructive Pulmonary Disease (COPD) exacerbation include viral and bacterial tracheobronchitis, pneumonia, and exposure to environmental irritants and air pollution. In many patients with COPD exacerbation, the underlying cause cannot be identified. In general, patients with COPD exacerbation get admitted to the hospital and treated with antibiotics, glucocorticoids and inhaled bronchodilators. Oropharyngeal dysphagia is an under-recognized provoking factor for COPD exacerbation. Patients with advanced COPD often have impaired coordination of respiration and deglutition which can lead to aspiration of liquids, food particles, and saliva into the airways. Aspiration events can lead to exacerbation of symptoms and cause further decline in lung function. We described a 69-year-old male with a history of COPD who presented with progressive dyspnea, productive cough and hypoxia which required intubation and mechanical ventilation. The patient underwent a bronchoscopy for airway inspection which showed pieces of meat in the right main bronchus which were removed. Reportedly, the patient was having difficulty swallowing solid food prior to admission to the hospital.

The most common provoking factors for chronic Obstructive Pulmonary Disease (COPD) exacerbation include viral and bacterial tracheobronchitis, pneumonia, and exposure to environmental irritants and air pollution. In many patients with COPD exacerbation, the underlying cause cannot be identified. In general, patients with COPD exacerbation get admitted to the hospital and treated with antibiotics, glucocorticoids and inhaled bronchodilators. Oropharyngeal dysphagia is an under-recognized provoking factor for COPD exacerbation. Patients with advanced COPD often have impaired coordination of respiration and deglutition which can lead to aspiration of liquids, food particles, and saliva into the airways. Aspiration events can lead to exacerbation of symptoms and cause further decline in lung function. We described a 69-year-old male with a history of COPD who presented with progressive dyspnea, productive cough and hypoxia which required intubation and mechanical ventilation. The patient underwent a bronchoscopy for airway inspection which showed pieces of meat in the right main bronchus which were removed. Reportedly, the patient was having difficulty swallowing solid food prior to admission to the hospital.