Classic radiographic features of tension pneumothorax, with near complete ipsilateral lung collapse, absence of lung markings beyond the pleural line, mediastinal shift and tracheal deviation to the contralateral side of the pneumothorax¹. This patient presented with a systolic blood pressure of 90 and an oxygen saturation of 88% without significant mediastinal shift demonstrated on imaging. Prompt insertion of a chest drain resulted in rapid restoration of hemodynamic stability. The patient had typical demographic features associated with development of a spontaneous pneumothorax such as a tall, thin body habitus and a history of vaping.