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Abstract 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.