Contralateral tension pneumothorax following unilateral chest tube drainage of bilateral pneumothoraces in a heart-lung transplant patient.

Bilateral pneumothoraces can result from unilateral air leak after heart-lung transplantation. The recommended initial management of such patients is insertion of a unilateral chest tube. We report a patient who developed bilateral pneumothoraces after undergoing transbronchial biopsies 2 years after a heart-lung transplant. The unilateral chest tube failed to drain the contralateral pneumothorax and a tension pneumothorax developed. The advocated approach should be used with caution.