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Spontaneous pneumothorax is a relatively common disease but its radiological diagnosis can be difficult because of the insufficient sensitivity of chest X-rays. This is even more so when bullous emphysema and acute pneumothorax co-exist. There is evidence that lung ultrasound is a valid instrument to detect a pneumothorax and a valid help in the differential diagnosis between pneumothorax and pulmonary blebs. We present a case which suggests the potential superiority of lung ultrasound on chest radiography in distinguishing free air (pneumothorax) from apical blebs, particularly when these are located in the posterior regions and may be easily confused with pneumothorax.