Background: The overexpression of transforming growth factor-beta 1 receptor II (TGF-${eta}1$RII) and transforming growth factor-beta 1 (TGF-${eta}1$) ligand may be involved in the formation of a bulla. In this study, we tested if serum TGF-${eta}1$ ligand levels correlated with the expression level of TGF-${eta}1$RII and TGF-${eta}1$ in bullous tissues from patients with spontaneous pneumothorax. Material and Method: Bullous lung tissues and blood samples were obtained from 19 patients with spontaneous pneumothorax, 18 males and 1 female, aged 17 to 35 years old. The bullous tissues were obtained by video-assisted thoracic surgery (VATS), fixed in formalin, embedded in paraffin, and cut into $5{sim}6{mu}m$ thick slices. Sections were immunohistochemically stained with primary antibodies against TGF-${eta}1$ or TGF-${eta}1$RII, and serum levels of TGF-${eta}1$ in patients and normal controls was measured by enzyme-linked immunosorbent assay (ELISA). Result: Of the 19 patients, 16 were TGF-${eta}1$ positive and 10 were TGF-${eta}1$RII positive. Among the 16 TGF-${eta}1$ positives, 9 were also TGF-${eta}1RII$ positive. As seen previously, strong immunohistochemical staining of TGF-${eta}1$RII and TGF-${eta}$ was detected in the boundary region between the bullous and normal lung tissues. Average TGF-${eta}1$ blood levels of both TGF-${eta}1$ and TGF-${eta}1$RII positive patients was $38.36{pm}16.2ng/mL$, and that of five controls was $54.06{pm}15ng/mL$. Conclusion: These results suggest that overexpression of TGF-${eta}1$ and TGF-${eta}1$RII expression may be involved in the formation of bullae. TGF-${eta}1$ blood levels in patients with primary spontaneous pneumothorax is lower than normal people, suggesting that the high level of local TGF-${eta}1$ expression in the bullous tissue region, but not in the whole blood, may contribute more in the formation of bullae.