Occurrence of a Simultaneous Bilateral Spontaneous Pneumothorax Due to a Pleuro- Pleural Communication Takashi Eguchi, MD, Kazutoshi Hamanaka, MD, PhD,

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Occurrence of a Simultaneous Bilateral Spontaneous Pneumothorax Due to a Pleuro- Pleural Communication Takashi Eguchi, MD, Kazutoshi Hamanaka, MD, PhD, Nobutaka Kobayashi, MD, Gaku Saito, MD, Takayuki Shiina, MD, Makoto Kurai, MD, Kazuo Yoshida, MD, PhD The Annals of Thoracic Surgery Volume 92, Issue 3, Pages 1124-1126 (September 2011) DOI: 10.1016/j.athoracsur.2011.03.066 Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Chest roentgenogram showing a bilateral lung collapse (arrowheads). (B) A computed tomographic scan revealing a bilateral lung pneumothorax with mediastinal emphysema (arrowheads) and several bullae in the apex of the left upper lobe (arrow). The Annals of Thoracic Surgery 2011 92, 1124-1126DOI: (10.1016/j.athoracsur.2011.03.066) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Intraoperative finding shows a small fistula, with repeating opening and closing, in the anterior mediastinal pleura (arrow). (B) The fistula visualized in (A) is closing (arrow). The Annals of Thoracic Surgery 2011 92, 1124-1126DOI: (10.1016/j.athoracsur.2011.03.066) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions