Multidisciplinary team approach on a case of bilateral tension pneumothorax

Case presentationA 63-year-old male patient was admitted to a local hospital with a four day history of bilateral chest tightness and pain without any recognizable cause.The symptoms worsened after physical activities, along with shortness of breath.At hospital admission, bilateral tension pneumothorax was diagnosed and emergency bilateral closed-chest drainage was performed; however, the symptoms did not improve.Patient was then he transferred to the Department of Cardiothoracic Surgery of Taizhou Hospital of Zhejiang Province for further evaluation and treatment.The patient had a history of chronic obstructive pulmonary disease (COPD) for 3 years but had no history of hypertension, coronary artery disease, or tuberculosis.The patient was non-smoker and did not consume alcohol.He did not work as pastor or miner and he was not exposed to any chemical substance.During physical examination, the pulse rate was 105 beats per minute, body temperature was 36.5 ℃, the respiratory rate (RR) was 25 breaths per minute, blood pressure 139/87 mmHg, body height 172 cm, and body weight was 46 kg.Orthopnea was diagnosed.Crepitus was palpable over his limbs, neck, chest wall, and scrotum.Tympany was heard during percussion in both lungs.Respiratory breath sounds were decreased, while no obvious dry or moist rales were heard.The cardiac rhythm was regular, and no obvious pathological murmur was noticed.Computer tomography (CT) at admission revealed bilateral pneumothorax, massive air accumulation in the subcutaneous tissues of the neck, mediastinum, chest wall/abdominal and pelvic walls, and both scrotums, minor bilateral pleural effusion, and patchy opacities in both lungs (Figure 1).Routine blood testing was performed: white blood cells (WBC), 8.2×109/L; hemoglobin (Hg), 131 g/L; neutrophil granulocyte ratio (N%), 92.2%; and absolute neutrophil count (ANC), 7.6×109/L.Arterial blood gas was analyzed: pH, 7.39; PO 2 , 88 mmHg; and PCO 2 , 44 mmHg.After admission to the hospital, the both chest tubes were placed under 2-5 kPa suction.At rest, the patient had an obvious air leak from both chest tubes.Cefoxitin combined with levofloxacin was given IV for antimicrobial

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