Simultaneous bilateral spontaneous pneumothorax is a rare disease that often presents with significant respiratory distress. Without in-time diagnosis and treatment, it can be fatal. High suspicion is necessary for every breathless patient, especially when there is malingancy or underlying lung diseases. Bedside ultrasonography or roentgenography can usually diagnose this disease. Tube thoracostomy, followed by detailed examinations and definitive treatment, is usually necessary because of the high risk of underlying diseases.