Pneumothoraces in patients with AIDS are a rare, acute and severe complication. Between January 1989 and December 1991 3 patients with spontaneous pneumothorax were operated after a 2-week treatment with chest tube drainage only had failed. The average follow-up time after the operation was 7 months. There was no recurrence. Within the same 3 years 3 patients were treated in the Clinic for Internal Medicine by means of tube drainage only. Thus, only one case was successful. The average survival after receiving the tube was 3 weeks. Their death was not related on their pneumothorax. The mean age of the 6 patients was 34 years (23-49). In 5 patients the pneumothorax was associated with Pneumocystis carinii-pneumonia and in 3 of them also with prophylactic pentamidine aerosol therapy. A minimal invasive operation of operable AIDS-patients with pneumothorax shows good results, shortens the time of therapy and is possible despite the bad prognosis of the disease.