question: Pneumothorax is an extremely common entity that is typically readily diagnosed and treated. Standard treatment for a small pneumothorax in an otherwise healthy patient is oxygen and observation. For many cases of pneumothorax (those that are larger, more symptomatic, occur in patients with underlying lung disease, or occur in patients who live far from an emergency facility), treatment includes needle aspiration or chest tube placement. We report the clinical presentation and imaging appearance of a 47-year-old female who had a trocar traverse the heart during pleural chest tube placement. Based on this case, policies in the emergency department were reviewed and quality measures were improved.