This is the case of a 78-year-old man treated with surgical aortic valve replacement. During the postoperative period, the patient developed right pneumothorax (Fig. 1A) that was treated with percutaneous pleural effusion using a 12-Fr chest tube. Right after insertion, the patient became hemodynamically unstable as confirmed by the leak of >500 mL of blood with pulsatile flow through the drainage within a few seconds. Immediate clamping was performed. An emergency thoracic x-ray confirmed the presence of drainage at right pulmonary artery level without associated hemothorax (Fig. 1B). Emergency surgery was planned to remove the drainage through direct visual control. The procedure revealed no active bleeding after removing the drainage. However, suture was performed at arterial insertion level to prevent further bleeding.

Figure 1

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