Abstract: Objective To discuss the distinguish method for huge pulmonary bulla and spontaneous pneumothorax with diagnosis and treatment of one case of huge pulmonary bulla. Methods This paper retrospectively analyzed the clinical data and treatment process of one case of huge pulmonary bulla in Dec. 2016 at respiratory department of the People′s Hospital of Jiangxia District ，Wuhan City. Results The case of huge pulmonary bulla appeared dyspnea，cough and hypoxemia after onset of the disease，the chest CT room emergently reported left pneumothorax. After surgery consultation，the doctor did not immediately carry out chest closed drainage. After reading of CT，it was considered that the photic zone was caused by tissue compression of huge pulmonary bulla and it was not spontaneous pneumothorax. The dyspnea was considered by acute attack of bronchial asthma. Conclusion In huge pulmonary bulla with pulmonary infection，it very easy appears chest distress，shortness of breath and other lung symptoms，and the huge pulmonary bulla is difficultly distinguished with pneumothorax，it may be cause misdiagnosis. The diagnosis of huge pulmonary bulla needs experience，reading of literature and knowledge of differential diagnosis.

Key words: huge pulmonary bulla, spontaneous pneumothorax, differential diagnosis