Simultaneous Bilateral Spontaneous Pneumothorax

Abstract

A 29-year-old Caucasian male presented with a sharp right-sided chest pain and worsening dyspnea of two days duration. He reported chronic cough with productive, purulent, non-bloody phlegm for two years. He denied fevers, chills, or weight loss. He lived in Kansas and denied foreign travel or incarcerations. He had a 20 pack-years cigarette smoking history. He also routinely smoked marijuana. The patient had leukocytosis with a white blood cell count of 18,400 (neutrophils 73%, lymphocytes 17%, and eosinophils 2%). A chest x-ray (Figure 1a) revealed bilateral spontaneous pneumothorax with complete left lung collapse, moderately large left pleural effusion, and 20% right-sided pneumothorax. A computed tomography (CT) of the chest (Figure 1b) showed diffuse lung cysts, including cystic bronchiectasis, and diffuse tree-inbud infiltrates in the right lung and large left pleural fluid with absence of identified normal lung tissue. There was no thoracic lymphadenopathy. Two chest tubes were placed, one on each side. A large amount of thick purulent fluid was evacuated from his left chest and sent for cultures.