Introduction: spontaneous pneumothorax is a potentially life-threatening condition but an under-recognised and rarely described complication of thoracic radiotherapy. We report a case of bilateral spontaneous pneumothoraces and radiation pneumonitis following moderate dose of thoracic radiation to the spine for high grade follicular lymphoma. case report: A 66-year-old caucasian male, non-smoker and no pre-existing pulmonary pathology, was diagnosed with low grade follicular lymphoma in 1999 and treated with chlorambucil and dexamethasone, followed by 30Gy radiotherapy to para-aortic lymph nodes. A subsequent relapse in 2005 was treated with a further eight cycles of chlorambucil and dexamethasone followed by radiotherapy to the pelvis. A second relapse in 2009 was managed with eight cycles of cyclophosphamide, vincristine and prednisolone and rituximab (cVP-r), followed by two years of maintenance rituximab. In 2016, the patient presented with thoracic back pain. Magnetic resonance imaging (MrI) demonstrated diffuse bony metastasis particularly at levels t2-t4 compressing the spinal cord that was decompressed surgically. biopsy confirmed diffuse large b-cell lymphoma.