Bilateral tension pneumothorax--is a prompt chest X-ray useful?

A 26-year-old man presented to the emergency department with sudden onset chest pain and dyspnoea at rest. He had no past history of chest problems. On examination, he was a moderately slender man, in severe respiratory distress and unable to speak in full sentences. His pulse was 111 min−1, blood pressure 200/111 mm Hg and oxygen saturation 89% on high flow oxygen via a non-rebreathing mask. Both sides of the chest were resonant to percussion and on auscultation there were diminished breath sounds bilaterally. A prompt chest radiograph showed complete collapse of both lungs. Immediate bilateral thoracostomy procedures relieved his cardiorespiratory distress. Subsequent video-assisted thoracoscopic surgery showed multiple bullae on both apical lung surfaces (Figure 1).