A 47-year-old woman was referred for evaluation of dyspnea and recurrent bilateral pneumothoraces, with the last episode requiring left apical resection and talc pleurodesis. The pathology from this procedure revealed only a scarred bleb lining. Dyspnea was described as insidious and gradually progressive since onset 5 years earlier. The medical history was notable for emphysema. The findings of a review of systems was otherwise negative, as was the family history. A social history revealed a 10 pack-year history of smoking with current use being described as sporadic. The physical examination findings were unremarkable with the exceptions of pulse oximetry values of 82% while breathing room air and a well-healed thoracotomy scar.