Spontaneous bilateral quadriceps tendon rupture is a rare finding in emergency departments. Thus, the pathophysiology is not well understood. Imaging for improved speed of diagnosis is rarely considered. We present a case of non-traumatic spontaneous bilateral quadriceps tendon rupture and examine current literature on the pathophysiology and imaging guidelines on the topic. The patient is a 49-year-old male that presented to the emergency department with bilateral thigh pain. He had been seen earlier with similar pain, but now presents with increased difficulty ambulating. The patient was found to have spontaneous rupture of bilateral quadriceps tendon. He was treated surgically and has been following with Orthopedic Surgery. Imaging in the emergency department included an ultrasound that showed tendon rupture. Spontaneous bilateral quadriceps tendon rupture is an uncommon finding in medicine and the emergency department. MRI remains the gold standard. However, clinical exam and ultrasound should be utilized for diagnosis of tendon rupture to hasten treatment.