Sequential Management of Bilateral Pneumothorax: A Case Report of Combined Chest Tube and Indwelling Pleural Catheter Interventions

We present the case of a patient with advanced lung cancer who initially experienced breathlessness and right-sided chest pain. A chest X-ray revealed a large right-sided pneumothorax, for which a right-sided chest tube was inserted. Due to a persistent air leak, a right indwelling pleural catheter (IPC) was placed. One week later, the patient developed a left-sided pneumothorax. To reduce the length of hospital stay, a left IPC was inserted. However, two days after this intervention, the patient returned with worsening breathlessness. A chest X-ray revealed bilateral pneumothorax despite the presence of the indwelling pleural catheters (IPCs). The bilateral IPCs were connected to an underwater sealed device, and bubbling was observed in the right IPC but not in the left. Consequently, a large-bore intercostal chest tube was inserted on the left side, resulting in significant improvement and full lung expansion. The right pneumothorax persisted, necessitating the insertion of a large-bore chest tube. Due to the continued air leak in both lungs, pleurodesis was performed, successfully resolving the pneumothorax. This case underscores that managing pneumothorax in advanced lung cancer patients may require various minimally invasive procedures and a transition from IPC to chest tube insertion when the initial approach fails. Prompt adjustment of treatment strategies can lead to the successful resolution of persistent air leaks and full lung expansion.