Simultaneous Bilateral Spontaneous Pneumothorax With Pleural Window Communicating With Bilateral Pleural Spaces

Congenital Pleuro-Pleural Communication Presenting as a Simultaneous Bilateral Spontaneous Pneumothorax: A Case Report

Bilateral spontaneous pneumothorax is a rare condition that accounts for approximately 1% of all pneumothorax cases. Most cases are attributed to underlying lung disease or prior thoracic surgery, as congenital pleuro-pleural communication is rare. We report the case of a 15-year-old girl with bilateral pneumothorax who underwent video-assisted thoracoscopic surgery. Intraoperative air leak testing unexpectedly revealed congenital pleuro-pleural communication. A retrospective review of preoperative computed tomography suggested a potential bilateral pleural communication between the esophagus and aorta. No intervention was performed to close the communication because of the technical challenges of achieving an airtight seal. The patient's postoperative course was uneventful, with no recurrence after 6 months. This case emphasizes the need to consider congenital pleuro-pleural communication in cases of bilateral pneumothorax, particularly in patients without prior thoracic surgery or bilateral bullae.

A 44-year-old man with bilateral pneumothorax

A 44-year-old man presented with a 3-day history of persistent upper-back pain, chest discomfort, and dyspnea. He denied any precipitating events such as trauma or vigorous activity before the presentation of symptoms. His exercise capacity had been excellent. He is a lifetime nonsmoker and never had significant lung problems apart from intermittent asthma for which he had several ED visits in the past. Chest CT scan performed during an asthma exacerbation 2 years earlier demonstrated two left-side lung blebs. He had no prior surgical procedures.

A case of simultaneous bilateral spontaneous pneumothorax after the Nuss procedure

We present a case of simultaneous bilateral spontaneous pneumothorax caused by a pleuro-pleural communication formed from Nuss procedure for pectus excavatum. A 17-year-old man with a history of Nuss operation complained chest pain and dyspnea. A chest roentgenogram demonstrated a tiny bilateral pneumothorax and two metallic bars inserted at the Nuss procedure. Computed tomography revealed furthermore a bulla in the apex of the left lung. The bilateral pneumothorax critically deteriorated after 4 days from onset and urgent bilateral chest drainages were performed. Nevertheless the drainages the full expansion of both lungs was not obtained and air leakage only from left side was continued. A video-assisted left bullectomy was performed 9 days after the tube insertion. The two bars penetrating anterior mediastinal pleura were thought to be a cause of the simultaneous bilateral spontaneous pneumothorax.

Simultaneous bilateral spontaneous pneumothorax: a rare emergency clinical condition

OBJECTIVE

Spontaneous pneumothorax is a disease that may cause serious respiratory distress and can be a life-threatening condition. A total of 1.3% of all spontaneous pneumothorax cases are simultaneous bilateral spontaneous pneumothorax (SBSP). In this study, because of its rarity, we discuss SBSP cases in light of previously reported cases.

MATERIALS AND METHODS

Between January 2004 and December 2009, SBSP was detected in five patients.

RESULTS

All patients were male, and the mean patient age was 18.6 (between 16 and 22 years of age). All patients had various degrees of dyspnea and chest pain. All diagnoses were established by chest X-rays. Two patients (40%) had primary spontaneous pneumothorax (PSP), and three (60%) had secondary spontaneous pneumothorax (SSP) (two patients had silicosis, and one had Staphylococcus aureus pneumonia). Previously, bilateral tube thoracostomies were performed on all patients. One PSP patient had a left apical pleurectomy with axillary thoracotomy; the other had a right apical pleurectomy. Tetracycline pleurodesis was performed on one of the silicosis patients. No additional surgical procedure or pleurodesis was performed on the other silicosis patient or on the pneumonia patient. No recurrence of pneumothorax was observed in any patient.

CONCLUSIONS

SBSP could be a life-threatening condition; therefore, urgent diagnosis and appropriate treatment of this condition can save patients' lives.