Is this really pneumothorax?

A 75-year-old female non-smoker was admitted for investigation of suspected interstitial lung disease. A left lower lobe transbronchial lung biopsy was performed, complicated by suspected bilateral pneumothoraces, pneumomediastinum and surgical emphysema (fig 1). Bilateral intercostal catheters (ICCs) were inserted. In view of the ongoing air leak and worsening surgical emphysema, a CT chest was undertaken. This was suspicious of extrapleural air leak. Following cardiothoracic consultation, video assisted thoracic surgery was performed which confirmed obliterated pleural spaces bilaterally with extrapleural air leak, as shown in fig 2. Bilateral ICCs were inserted into the air filled extrapleural space with dramatic reduction in surgical emphysema. The patient declined further invasive investigations.