On placement of the chest drain, 800 mL of fresh blood immediately drained. The patient was shocked, and was taken straight to theater for exploration and hemorrhage control. 

Tension hemothoraces are uncommon but are life threatening causing both obstructive and hemorrhagic shock. 

This case also demonstrates the difficulty of trauma radiography with centering and collimation challenging in the setting of unstable patients requiring multiple urgent procedures at the same time as acquisition.