Introduction. Simultaneous bilateral spontaneous pneumothorax (SBSP) is a potentially life-threatening state that may imitate many lung diseases. The aim of this report was to describe the presentation and highlights the potential difficulties in diagnosis and management of patients with SBSP. Case outline. A 23-year-old female was urgently assessed because of a progressive dyspnoea of 2-day's duration with associated bilateral chest pain. Lung auscultation revealed equally diminished breath sounds on both sides. During initial examination, there was the evidence of symptomatic deterioration with bilateral pleuritic chest pain, increased dyspnoea and agitation. She was found to have type II respiratory failure with the following biochemical parameters: pH=7.34, PaCO2=6.3 kPa and PaO2=7.9 kPa. The chest radiograph confirmed bilateral partial pneumothoraces of approximately 30%. Both left and right-sided thoracostomies with large-bore chest drain insertions were performed emergently, followed by partial resolutions of pneumothoraces. CT of the chest demonstrated residual pneumothoraces bilaterally with multiple apical bullae. In the further course, she subsequently underwent video-assisted thoracoscopic surgery with bilateral apicoectomies, bullectomies and pleural abrasion. Her chest drains were removed 3 days after surgery and a chest radiograph post-treatment demonstrated resolution of the pneumothoraces. She was discharged home without complications. Conclusion. Using clinical presentation, diagnostic algorithm and therapeutic management applied in the case of our patient, we emphasized a few mandatory steps in establishing the diagnosis of SBSP and further treatment.