Simultaneous bilateral spontaneous pneumothorax

Introduction Simultaneous bilateral spontaneous pneumothorax (SBSP) is a potentially life-threatening state that may imitate many lung diseases. The aim of this report was to describe the presentation and highlight potential difficulties in diagnosis and management of patients with SBSP. Case outline A 23-year-old female patient was urgently assessed because of a progressive two-day-long dyspnoea with associated bilateral chest pain. Lung auscultation revealed equally diminished breath sounds on both sides. During the initial examination, there was evidence of symptomatic deterioration with bilateral pleuritic chest pain, increased dyspnoea, and agitation. The patient was found to have type II respiratory failure with the following biochemical parameters: pH 7.34, PaCO2 6.3 kPa, and PaO2 7.9 kPa. A chest radiograph confirmed bilateral partial pneumothoraces of approximately 30%. Both left- and right-sided thoracostomies with large-bore chest drain insertions were performed emergently, followed by partial resolutions of pneumothoraces. CT of the chest demonstrated residual pneumothoraces bilaterally with multiple apical bullae. In the further course, the patient subsequently underwent video-assisted thoracoscopic surgery with bilateral apicoectomies, bullectomies, and pleural abrasion. Her chest drains were removed three days after surgery and a post-treatment chest radiograph demonstrated resolution of the pneumothoraces. She was discharged without complications. Conclusion Using clinical presentation, diagnostic algorithm and therapeutic management applied in the case of our patient, we emphasized a few mandatory steps in establishing the diagnosis of SBSP and further treatment.