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Background Surgically managed pneumothorax cases are at increased risk of underlying lung pathologies, with 10% of patients believed to have a genetic predisposition. Histopathological features of pneumothorax lung tissue can be divided into non-specific and specific findings, with the latter suggestive of a pre-existing lung condition. Microscopic evaluation plays a crucial role in identifying clinically unsuspected pathogenesis which may require follow-up.Aims and Objectives To evaluate the institutional incidence and indications of surgically treated pneumothorax cases, as well as incidental histological findings of pulmonary pathologies in this cohort.Methods A ‘CORVU’ search of the Laboratory Information Management System at the Department of Pathology from was performed from January 2019 to December 2024, utilizing SNOMED codes for Pneumothorax and Bulla. Study data was collected and analysed utilising Microsoft Excel.Results 7%(n=89) of the 1302 surgical lung specimens retrieved over the study period were surgically treated pneumothorax cases, with an age range of 14–69, and median age of 30. The male: female ratio was 3:1. Recurrent pneumothorax was the most common indication for surgery in 52%(n=46). 89%(n=80) of cases were spontaneous, 11%(n=9) were secondary. 25%(n=20) of spontaneous cases had emphysematous change, of which 55%(n=11) were <40 years old. Of these, 45%(n=5) were smokers. All secondary cases had emphysematous change. Nonspecific histological features in the spontaneous cohort were predominantly pleuritis (75%, n=60), bullae and fibrosis (73%, n=58). Of the spontaneous cases, 20 were smokers, 11 were ex-smokers, 10 were nonsmokers, the remainder had unknown smoking status. Assessment of the nonsmoking group revealed 50%(n=5) had abnormal airspace enlargement.Atypical adenomatous hyperplasia (AAH) was identified in 10%(n=8) of spontaneous cases, of which 75%(n=6) were <40 years old. 50% were smokers, 50% had unknown smoking status, however those with unknown smoking status had microscopic smoking-related changes of respiratory bronchiolitis (n=3) and emphysematous change (n=2). One of these AAH cases was also diagnosed with Langerhans cell histiocytosis. No malignancies were identified.Conclusion Histopathological examination of lung tissue can yield important incidental findings in surgically treated pneumothorax patients, which require appropriate follow-up. Clinical outcomes and follow-up data for this patient cohort is currently being analysed.