Spontaneous pneumothorax is caused by the rupture of pulmonary blisters, which is a common disease in thoracic surgery, and is prone to recurrence with conservative treatment, and can be cured by complete removal of pulmonary blisters with minimally invasive thoracoscopic surgery. Two patients, both young males, with sudden onset of chest pain and chest tightness, were diagnosed as spontaneous pneumothorax in the emergency department of our hospital. Both patients developed massive hemothorax (hemorrhage in the chest cavity) and hemorrhagic shock on the next day, so our department performed emergency thoracoscopic minimally invasive surgery and found bleeding from the ruptured thoracic adhesion band. Therefore, simple pneumothorax should also be treated actively as early as possible, and hesitation may lead to aggravation of the disease.