Pneumothorax presenting as epigastric pain

A male patient who smoked heavily complained of severe epigastric pain. He also had mild chest pain for the last 4 weeks. Imaging tests revealed pneumothorax secondary to cystic changes probably as a result of chronic obstructive pulmonary disease. Pneumothorax, particularly slowly progressive one, may present as abdominal pain. In addition to cardiovascular and gastrointestinal diseases, pneumothorax should be considered as a differentiasl diagnosis of epigastric pain with preceding pain or other symptoms in a heavy smoker.