Abstract: Objective To put forward the suggestions for medical assessment of spontaneous pneumothorax in aircrew by summarizing its diagnosis, treatment and medical assessment in a pilot. Methods The diagnosis, treatment and medical assessment of spontaneous pneumothorax in a pilot admitted to our hospital were retrospectively analyzed. Suggestions were put forward for the medical assessment of spontaneous pneumothorax in aircrew by summarizing the clinical data about 5 aircrew with blebs found in physical examination in the past 5 years. Results The patient was a male pilot aged 39 years. He was admitted to our hospital because of mild chest pain. X-ray showed hydropneumothorax in his right chest with 70% of the right lung compressed. Six months after he was treated with closed thoracic drainage and oxygen inhalation his lungs were fully expanded with their function recovered.Medical assessment concluded that he was qualified for flying a double-seats aircraft. No pneumothorax was detected in physical examination of the other 5 aircrew with blebs. Conclusion Whether aircrew with spontaneous pneumothorax are qualified to fly should be assessed depending on the attacks of pneumothorax, sites of blebs, types of aircraft, and desire of aircrew to fly.