Talc-induced pulmonary granulomatosis is an unusual condition resulting from the intravenous administration of medications intended for oral use. A patient with this condition who presented with a spontaneous tension pneumothorax is reported. Although the radiographic findings of a diffuse reticulonodular pattern are typical, this patient was found to have diffuse, small cavitary pulmonary nodules. Surgeons should be aware of this rare condition and should have a low threshold for performing a thoracoscopic lung biopsy.