We report five cases of spontaneous pneumothorax as the first sign of pulmonary carcinoma. Initial tests did not detect neoplasms. Diagnosis took place during surgery for four patients and the fifth was diagnosed by preoperative computed tomography to assess pulmonary bullous emphysema. All five patients had persistent air leaks in spite of correct placement and functioning of drains, the reason for which surgery was scheduled. Three segmentectomies, one lobectomy and one exploratory thoracotomy for pleural metastasis were performed. Histopathologic diagnoses were 3 giant cell tumors, 1 adenocarcinoma and 1 non-mucinous bronchoalveolar carcinoma. We think that when risk factors are present, the existence of unresolved pneumothorax after correct placement of a drain should lead to a suspicion of associated pulmonary carcinoma.
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