Simultaneous bilateral spontaneous pneumothorax with congenital pleuro-pleural communication

Abstract

A single pleural space can lead to serious simultaneous bilateral pneumothorax in cases of congenital or acquired pleuro-pleural communication. Here we report a 35-year-old man with bilateral pneumothorax. Chest computed tomography scans revealed a small air space between the esophagus and aorta, suggesting pleuro-pleural communication. Bilateral thoracoscopic bullectomy was performed. Repeated inspection revealed a 2-cm-long pleural window between the aorta and esophagus, which was closed with a collagen patch. Although congenital pleuro-pleural communication has been regarded as rare, as many as nine patients have been reported (if suspected cases are included). The lower middle mediastinum should be carefully inspected.

Keywords: Bilateral pneumothorax; buffalo chest; pleuro-pleural communication; single pleural space.

Figure 1

A. Chest CT scan showing simultaneous bilateral pneumothorax and a small air space, suggesting the presence of a pleuro-pleural window (arrow) next to the esophagus (arrowhead); B. Thoracoscopic image showing a 2-cm-long pleural window posterior to the inferior pulmonary ligament — between the descending aorta (left) and esophagus (right), at approximately 2-3 cm above the diaphragm (upper) — through which the contralateral lung can be seen.