Tension hemothorax is a rare but life-threatening disorder.

The patient had an immediate thoracoscopic evacuation of the hemothorax and exploration of the right thoracic cavity as well as placement of two large-bore chest tubes.

Video-assisted thoracoscopic surgery (VATS) did not reveal any intrathoracic bleeding source, with unremarkable visceral and parietal Pleura.

The bleeding source was suspected to be an extrathoracic vessel (venous varix or branch of the lateral thoracic artery) and related to the withdrawal of the chest drain earlier the same day.

So the CT did help in the diagnosis and localization of the bleeding site. 

The patient had a full recovery.

Side note on the central venous catheter (CVC) tip position:

Hemothorax is also a recognized complication of central venous catheterization.

Even though central venous catheter tip position is a somewhat controversial issue, in this case, the tip of the internal jugular vein catheter is obviously pointing towards a vessel wall (junction of distal IVJ and left brachiocephalic vein) and therefore “not ideal”.