Spontaneous pneumothorax accompanying primary lung cancer is rare and its occurrence as an initial sign of primary lung cancer is much rarer. A few articles on spontaneous pneumothorax accompanying lung cancer have been published in Korea so far. Lung cancers, diagnosed after spontaneous pneumothorax, are usually in advanced stage, so that conservative treatment modalities such as closed tube thoracostomy, chemotherapy, or radiotherapy are the mainstream of the treatment. We experienced a case of local recurrence of primary lung cancer in six months after radical resection and radiotherapy of neoplasm performed immediately after the diagnosis by excisional biopsy of bulla, for which resection and pleurodesis had been done under the impression of spontaneous pneumothorax. In this paper, we report the case and follow-up observation of the patient.