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Fig. 3. —49-year-old man with giant bullous emphysema and spontaneous right pneumothorax. Chest CT scan shows large asymmetric upper lobe bullae. Chest tube is located peripherally in right pleural space. Note presence of air in pleural space surrounding anterior bulla on right (arrow) and parallel configuration of bulla wall with chest wall. This is double-wall sign of pneumothorax. This case illustrates benefit of identifying this sign to distinguish intraparenchymal air, as seen in huge bullae on left, from small pneumothorax surrounding these large bullae on right.