With the recent resurgence of tuberculosis (TB) in western countries, the incidence of complicating secondary pneumothorax has also increased. The work-up and management of this complication differs from that in other types of secondary spontaneous pneumothorax (SSP). Our objective was to assess clinical features and therapeutic modalities of SSP in patients with and without active pulmonary tuberculosis (APTB). All patients diagnosed with SSP seen at the Hospital Xeral of Vigo from January 1990 to June 1995 were candidates for this study. Full clinical, radiological and examinations were performed in all patients. Invasive procedures (thoracic catheter aspiration, thoracoscopy and thoracotomy) and mean hospital stay were compared in patients with and without APTB. Forty-eight patients with SSP were enrolled. Eleven patients (10 males and one female, mean age 30 +/- 11 years) had APTB; and 37 patients (31 males and six females, mean age 49 +/- 20 years) had conditions other than APTB. Chest pain, cough and fever were more frequent in patients with APTB (90% vs 59%; 45% vs 13.5%; 36% vs 5%, respectively). Catheter aspiration was successful in three of 10 (30%) of patients with APTB and in 15/23 (60.86%) of those without APTB. Catheter aspiration time was longer in the former group (25 +/- 22 days vs 13 +/- 11 days, P = 0.17). As initial treatment, thoracoscopy was performed in seven of 37 (18.91%) of those without APTB and in one of 10 (10%) patients with APTB. For patients with unsuccessful catheter aspiration, thoracoscopy was performed in eight of nine (89%) patients without APTB and in none of the patients with APTB. Thoracotomy was performed in only one of nine (11%) without APTB and in four of seven (57%) patients with APTB. Patients with APTB had a longer hospitalization (41 vs 18 days, P < 0.001). We concluded that SSP and APTB was a frequent association in our study. Patients with APTB showed a lesser and slower response to catheter aspiration. Despite severe clinical presentation and demand for more invasive procedures, patients with APTB showed a favourable response.