METHODS A middle-aged man presented with the diagnosis of typical spontaneous pneumothorax in the left chest. His management was initiated as usual with a chest drain and he had an uneventful recovery with good expansion of the affected lung up until the third postoperative day. But due to a fatal accident, the patient connected the oxygene supply tube into his thoracic drain. This high pressure caused a left, and a consequent bilateral pneumothorax with massive subcutanous emphysema, being the cause of a preterminal status. Cardio-pulmonary resuscitation was unsuccesfull and the patient died. Intentional suicide was excluded by forensic investigations. CONCLUSIONS According to our knowledge, no similar case with this mechanism of tension pnemuthorax has been published in the literature so far. The pathophysiology is similar to lung damage due to high-pressure ventillation with consecutive tension pneumothorax.