Primary spontaneous pneumothorax mostly occurs in tall and thin young male. Rupture of bullae or blebs on the visceral pleural surface is regarded to result in pneumothorax in this patient. Primary spontaneous pneumothorax can be managed by conservative or surgical methods. The development of video-assisted thoracoscopic surgery (VATS) made this procedure as one of important treatment options for this patient. VATS treatment is indicated for recurrent cases, those who are refractory to conservative treatments or visible bullae/blebs on image findings. Chest computed tomography can be used to assess the existence and location of bullae/blebs on the ipsilateral or contralateral side, as well as the severity of pleural adhesion. These above information is important to determinate subsequent decision and plan of management.