Video-assisted thoracoscopic surgery has become the criterion standard for the management of uncomplicated, primary spontaneous pneumothorax. However, for patients with concomitant massive hemothorax and shock, open thoracotomy is considered first. We report the case of a 16-year-old male patient who presented with left hemopneumothorax and contralateral mild pneumothorax. After bilateral tube thoracostomies, approximately 2000 mL of fresh blood was evacuated from the left chest cavity. Thereafter, the patient was successfully treated with emergent, single-stage bilateral thoracoscopic operation.
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