Bilateral Spontaneous Pneumothorax in a Young Gentleman

Bilateral spontaneous pneumothorax is a rare condition that occurs mainly in patients with underlying lung disease. We report the case of a 26-year-old Chinese male with a history of smoking who presented with sudden onset of chest tightness and dyspnoea. Chest radiography revealed bilateral pneumothoraxes, prompting the insertion of bilateral chest tubes. Further imaging with high-resolution computed tomography of the chest revealed multiple bilateral, thin-walled cysts with relative sparing of the lung bases and tiny peripheral nodules. The patient underwent bilateral video-assisted thoracoscopic surgery with bullectomy, pleurodesis, and surgical lung biopsy. Histopathological examination revealed cysts lined by Langerhans cells with eosinophilic infiltration, establishing the diagnosis of pulmonary Langerhans cell histiocytosis (PLCH). This case highlights the importance of considering cystic lung diseases, particularly PLCH, in young smokers presenting with spontaneous bilateral pneumothorax. Radiologic and histopathologic correlation is essential for definitive diagnosis. Smoking cessation remains the cornerstone of management.