Background: Two male patients, one with small cell lung cancer and one with squamous cell lung cancer, presented within a few days of each other with incidental pneumothoraces on their routine staging computed tomograms. Case Presentation: Both patients were sent to the accident and emergency from the radiology department. The patient with small cell lung cancer was seen out of hours, had a chest drain, and was admitted. The drain fell out with resultant extensive surgical emphysema. Specialist pleural advice was sought and instead of further interventions, simple observation in a place of safety enabled resolution of the pneumothorax, the surgical emphysema and symptoms. The second patient was seen within working hours with specialist pleural advice: simple observation over time allowed resolution of symptoms. Conclusion: We hence describe the harm that a chest drain performed out of hours caused harm.

Keywords: Pneumothorax, chest drain, secondary pneumothorax, case report