Spontaneous pneumothorax is mostly caused by rupture of subpleural pulmonary blisters, but it is also seen in other causes such as collapse of subpleural lesions or cavities and tearing of pleural adhesion bands. Subpleural pulmonary blisters can be congenital or secondary. The former is often confined to the pulmonary apex and is seen in long, thin men with no obvious disease on chest X-ray, while the latter is commonly formed on the basis of obstructive emphysema or post-inflammatory fibrous lesions with semi-obstruction and distortion of the fine bronchi, producing a live valve mechanism. The distended pulmonary blisters degenerate due to nutritional and circulatory disturbances such that they rupture during coughing or increased intrapulmonary pressure, resulting in spontaneous pneumothorax. These pulmonary blisters can be located anywhere in the lung lobes, and some of them are multiple. There is general agreement on the surgical treatment of patients with spontaneous pneumothorax due to ruptured pneumomediastinum. For those with solitary isolated pulmonary bullae, especially those with massive pulmonary bullae affecting lung function, surgical resection is the mainstay. For multiple pulmonary blisters, especially those similar to grape bunches, suturing and ligation of the leaking pulmonary blisters are the main treatment, while other pulmonary blisters are treated with pleural adhesions to promote adhesion of the lung to the chest wall. Medical OB glue is used for clinical trials, and the test idea is that: the pulmonary blister itself does not have respiratory function, and is often connected to small bronchi. Once ruptured, it leads to spontaneous pneumothorax. Injecting medical OB glue into the cavity of the blister to make it stick closed, which not only blocked the air leakage of small bronchi, but also eliminated the pulmonary blister with little damage to normal tissue.