Pneumothorax spontané simultanément bilateral

Pneumothorax is a gaseous effusion between the parietal and visceral pleura. Spontaneous pneumothorax is exceptionally bilateral hence the peculiarity of this study. The study reports the case of a 47-years old patient having 35 pack year smoking history, suffering from chronic bronchitis since 8 years, admitted to the emergency department with diffuse thoracic pain, polypnea, intercostal and substernal indrawing and cyanosis of the extremities. The most problable diagnosis were: COPD exacerbation, pulmonary embolism or pneumothorax. Pleuropulmonary examination showed bilateral pleural effusion syndrome. Chest X-ray showed bilateral avascular lucency accentuated on the left side. CT of the chest showed bilateral pneumothorax accentuated on the left side associated with multi-bullous lung. The patient underwent pleural drainage of the left lung (the most collapsed one) set to gentle suction (-20 cm H2O), exsufflation on the contralateral side and symptomatic treatment with intravenous corticosteroids (Solumedrol) associated with nebulized salbutamol, antibiotic coverage and strict bed rest. Evolution was marked by the re-expansion of the 2 lungs to the chest wall.