Mr. MS is a 36 year old man who presented with sudden onset of left chest pain and shortness of breath associated with fever and cough. On examination, he had signs of respiratory distress such as asymmetry of chest wall expansion and tracheal deviation. A provisional diagnosis of tension pneumothorax was made based on the clinical presentation and physical exam findings. Immediate needle thoracostomy was performed followed by chest tube insertion to treat the tension pneumothorax.