Bilateral pneumothorax is a condition in which air collects in the space between each lung and the chest wall, causing both lungs to partly or fully collapse. The trapped air prevents the lungs from expanding normally, making breathing difficult. It can happen after a chest injury or medical procedure, or without a clear trigger. Because both sides are affected, it needs urgent medical assessment and may require rapid treatment.
What Happens in Bilateral Pneumothorax?
The lungs sit inside the chest, surrounded by a thin lining called the pleura. A small space between the lung lining and the lining of the chest wall is known as the pleural space. Normally, this space helps the lungs move smoothly as a person breathes.
When air enters the pleural space, it creates pressure on the outside of the lung and prevents the lung from expanding normally. This is called a pneumothorax, or collapsed lung. According to the Merck Manual, a pneumothorax can cause partial or complete lung collapse.
In a bilateral pneumothorax, air collects in the pleural space on both the right and left sides of the chest. The lungs may not be affected equally: one side may have a larger collection of air or greater lung collapse than the other. When both lungs are affected, the amount of air available for normal breathing can be reduced, and the person's condition may become critical.
What Causes Bilateral Pneumothorax?
A bilateral pneumothorax can occur after an injury, a medical procedure, or the rupture of a small air pocket in the lung. Sometimes, it develops without an obvious cause. The factors associated with pneumothorax include:
- Chest injury: A serious blow to the chest, a rib fracture, or a penetrating injury can damage the lung or chest wall and allow air to enter the pleural space.
- Underlying lung disease: Conditions such as chronic obstructive pulmonary disease (COPD), emphysema, cystic fibrosis, and certain other lung disorders can increase the risk of a pneumothorax.
- Spontaneous rupture of small air pockets: Small air-filled areas called blebs or bullae may develop on or within the lung. If one ruptures, air can escape into the surrounding space even without an injury.
- Medical procedures: Procedures involving the chest or lungs, placement of certain central venous catheters, and mechanical ventilation can sometimes cause a pneumothorax.
- Smoking and other risk factors: Smoking increases the risk of pneumothorax. A spontaneous episode can also occur in a person with no previously diagnosed lung disease.
MedlinePlus, a service of the US National Library of Medicine, describes these causes and explains that some pneumothoraces develop without a clear triggering event. These factors can contribute to pneumothorax, but they do not necessarily mean that a person will develop bilateral disease.
What Are the Symptoms of Bilateral Pneumothorax?
Symptoms depend on how much air has collected, how much the lungs have collapsed, how quickly the condition has developed, and whether another lung problem or injury is present. When both sides are affected, breathing may be significantly impaired.
Possible symptoms include:
- Shortness of breath: Breathing may feel difficult, uncomfortable, or unusually rapid.
- Sudden chest pain: Pain may feel sharp and become more noticeable with a deep breath or coughing.
- Chest tightness: Some people experience pressure or discomfort in the chest.
- Rapid heartbeat: The heart may beat faster as the body responds to breathing difficulty or reduced oxygen levels.
- Lightheadedness or faintness: These symptoms can occur when the condition affects normal circulation or oxygen delivery.
- Bluish lips or skin: A blue or gray color may indicate dangerously low oxygen levels, particularly when accompanied by breathing difficulty.
The Cleveland Clinic identifies chest pain, shortness of breath, rapid breathing, and a rapid heart rate among the symptoms associated with pneumothorax. Symptoms alone cannot establish whether one or both lungs are affected.
When to seek emergency care: Sudden difficulty breathing, new or sudden chest pain, fainting, or blue or gray lips or skin requires immediate medical attention. Call your local emergency number, particularly if symptoms are sudden or worsening. Do not wait for symptoms to become more severe.
Why Can Bilateral Pneumothorax Be Dangerous?
The main concern is that both lungs may have less capacity to expand and support normal oxygen exchange. The resulting breathing difficulty can be serious, particularly when there is substantial lung collapse, an underlying lung condition, or a significant chest injury.
Another possible complication is tension pneumothorax. This occurs when air continues to accumulate in the pleural space and pressure rises because the air cannot escape adequately. The increasing pressure can compress the lung and interfere with blood returning to the heart, causing a dangerous drop in blood pressure.
The Merck Manual's guidance on tension pneumothorax explains that this is a life-threatening emergency requiring immediate treatment. Healthcare professionals act on strong clinical evidence of tension pneumothorax without waiting for an imaging test when doing so would delay essential care.
How Is Bilateral Pneumothorax Diagnosed?
Diagnosis involves assessing the person's breathing, circulation, medical history, symptoms, and possible causes, such as recent chest trauma or a medical procedure. A clinician may listen to the chest with a stethoscope and check oxygen levels, heart rate, breathing rate, and blood pressure. Reduced breath sounds on one or both sides may raise concern, but examination findings alone may not show the full extent of the problem.
Imaging is generally needed to confirm the diagnosis and determine which sides are affected. Tests may include:
- Chest X-ray: Often the first imaging test used to identify air outside the lungs and assess the extent of lung collapse.
- Chest ultrasound: May help identify pneumothorax, particularly in emergency or critical-care settings.
- Computed tomography (CT) scan: Provides more detailed images and may be used when an X-ray does not fully explain the findings or when associated chest injuries or lung conditions need assessment.
According to the Mayo Clinic, pneumothorax can be diagnosed using a chest X-ray, with CT scans or ultrasound used when appropriate. The choice of test depends on the person's condition and the clinical circumstances.
How Is Bilateral Pneumothorax Treated?
Treatment aims to remove trapped air when necessary, allow the lungs to expand again, support breathing, and address the cause. Because both sides are involved, hospital assessment is important to determine how urgently treatment is needed. The treatment plan depends on the person's stability, oxygen levels, imaging results, underlying lung health, and whether pressure is building inside the chest.
Chest drainage
A chest drain is a thin tube inserted through the chest wall into the pleural space to allow trapped air to escape. Depending on the findings, a drain may be needed on one side or both sides. The healthcare team monitors the person's breathing and uses follow-up imaging to assess whether the lungs are re-expanding and whether the air leak has stopped.
The Guy's and St Thomas' NHS Foundation Trust explains that a chest drain removes air from the space between the lung and chest wall, helping the lung work properly again. The drain may remain in place for hours or days, depending on the clinical situation.
Other treatment options
Depending on the person's condition, treatment may also involve supplemental oxygen when needed, or needle aspiration to remove air in selected cases. If a tension pneumothorax is suspected, urgent decompression is required, followed by appropriate chest drainage.
Some small, stable pneumothoraces can be managed with careful observation and repeat imaging. However, observation is not appropriate for every case, and bilateral involvement requires careful assessment before clinicians decide on the safest approach. Surgery may be considered if an air leak does not resolve or if pneumothorax repeatedly returns.
What Is Recovery Like After Bilateral Pneumothorax?
Recovery depends on the amount of lung collapse, the cause of the pneumothorax, the treatment required, and the person's overall lung health. Some people recover after the trapped air is removed and the air leak heals. Others need a longer hospital stay, additional procedures, or treatment for an underlying lung condition.
Follow-up may include a clinical review and repeat chest imaging to confirm that the lungs have re-expanded and the pneumothorax has resolved. People who have experienced a pneumothorax may be at risk of another episode, although the level of risk varies. Smoking cessation and appropriate management of underlying lung disease may help reduce relevant risk factors.
Before returning to activities such as air travel, scuba diving, strenuous exercise, or heavy physical work, follow the treating clinician's advice. The appropriate timing depends on recovery, test results, and the activity involved.
When Should You Contact a Healthcare Professional?
A suspected pneumothorax needs prompt medical assessment, and symptoms such as sudden chest pain or shortness of breath should not be ignored. If bilateral pneumothorax has already been diagnosed, follow the hospital team's instructions and attend recommended follow-up appointments. Seek emergency care immediately if breathing becomes more difficult, chest pain worsens suddenly, faintness develops, or lips or skin turn blue or gray.