A 53-year-old man was admitted to our hospital with a recurrence of spontaneous pneumothorax. He had no history of other diseases including chronic lung diseases. A month prior to this admission, he had a first pneumothorax and was treated with 4 days of intercostal drainage. CT scan showed no bulla, but revealed multiple small polygonal lesions consistent with fibrotic lesions mainly in the right lower lobe (figure 1). We performed right thoracotomy and found that air leakage arose from torn visceral pleura which had been pierced by a drumstick-shaped bony structure (figure 2 …