Introduction: Chest tube insertion is an established cause of iatrogenic pneumothorax and can be associated with significant subcutaneous emphysema. Inspection for reposition, replacement or removal of clogged blockage can be a lifesaving act against fatal tension pneumothorax. If chest tube is to be improvised, adherence to evidenced – based principle of chest tube drainage system with attention to underwater seal principle is essential.
Case Report: A patient with trauma had improvised Foleys catheter and urine bag as chest drainage system with resultant ballooning of the urine bag with air and development of tension pneumothorax.
Conclusion: This report highlights the danger of improvising a chest drainage system while ignoring its scientific basis as a cause of tension pneumothorax.