**1. Introduction**

The Red Indians knew that the North American buffalo had a single pleural cavity. A single arrow to the chest was enough to collapse both lungs and expedite the death of the beast. On the other hand, the elephant is unique insofar as it is the only mammal whose pleural space is obliterated by connective tissue. This natural pleurodesis has been known for over 300 years but only recently explained [1]. Apparently, the elephant is the only mammal that can remain submerged far below the surface of the water while snorkelling. It is intriguing though that the foetal elephant has normal pleural spaces that obliterate later in gestation [2]. Humans are slightly luckier; they enjoy two pleural spaces separated by mediastinal structures; if one lung collapses, the other one sustains life. However, there are reports in the literature of some patients with pleuro-pleural congenital communications, presenting with simultaneous bilateral pneumothoraces, the so-called buffalo chest [3].

Humans collapse their lungs frequently, and the different ways we deal with this common condition match its frequency. There is bound to be differences in opinion, and the multicentre randomised controlled trials (RCT) have not come up with a solid protocol to guide management. There was no general agreement on therapy when Ruckley and McCormac of the Royal Infirmary of Edinburgh described the management of pneumothorax in 1966 [4]. There is no agreement at our present time still, despite the technological advances in our knowledge and the available randomised controlled trials. We could not agree more with Robert Cerfolio et al. on their statement that "although thoracic surgeons are the best trained physicians to manage chest tubes and pleural problems, they often do not speak the same language or recommend similar treatment algorithms even to each other" [5].
