Résumé
Haemothorax following emergency needle thoracentesis [NT] for tension pneumothorax [TP] is a rare though serious complication [1]. We present a case of massive haemothorax, subsequent to the transection of the first intercostal artery by a misplaced needle during thoracentesis. The case highlights the need for emphasis upon precise and safe location of the landmarks for the procedure. The authors suggest replacing the teaching of the safe interventional landmark, from the currently advocated [along the upper border of the lower rib], to the safer site of the [middle of the intercostal space]. We also propose that resuscitation manuals and courses should stress locating the [angle of Louis] or the manubro-sternal angle to correctly identify the second rib. A 23 year old male presented to the emergency department with 2 hour history of sudden onset, left sided chest pain and shortness of breath. The patient had no history of any significant previous illnesses or allergies. A non-smoker, he was not on any regular medications. Physical examination showed he was not distressed, haemodynamically stable [blood pressure 112/85 mmHg] and maintaining an oxygen saturation of 97% on room air. There was decreased air entry in the left upper chest with a hyper-resonant percussion note. The rest of the systemic examination was unremarkable. A working diagnosis of spontaneous pneumothorax was made. This was confirmed by a chest X-ray which showed nearly 50% collapse of the left lung [Fig.1]