Spontaneous pneumothorax is a relatively common disease in the clinical practice setting and is generally recognized to occurs most often in slender young men. However, spontaneous pneumothorax that occurs bilaterally and simultaneously and progresses to tension pneumothorax has rarely been documented. Although spontaneous pneumothorax can be diagnosed based on the patient's medical history or information from ambulance personnel, it should be remembered that there are some rare cases of bilateral tension pneumothorax. Prompt and appropriate diagnosis and treatment are necessary for patients with such conditions, which may can be life-threatening.