YN/M/5yoChief Complaint : shortness of breath It had been suffered since 2 days. Patient with esophageal stricture, and undergone esophageal busination operation under GA-ETT (+) 2 days before, by ENT colleague. History of CVC installation (-). History of laparotomy due to hiatal hernia one year ago. Patient was hospitalized in pediatric ward.Present State: Awareness : Alert HR

: 114x/i RR

: 46x/i Temp

: 37.2 CGeneralized State: Head

: no abnormalities found Neck

: in localized state Chest

: in localized state Abdomen: I : symmetris, transverse supra umbilical operation scar (+) P : Firm and smooth P : Thympani A : Peristaltic (+) N Genitalia : male, no abnormalities found Extremities: no abnormalities foundLocalized State: Neck : Trachea was shifted to the right

Jugularis Vein Pressure R+3 cm Chest: I : (L) hemithorax was left in respiration P: hypersonor o/t (L) hemithorax A: breathing sound disappeared o/t (L) hemithorax Working diagnose : (L) Tension pneumothorax ( Needle thoracosinthesis Treatment - O2 10 l/i - Needle thoracosinthesis - IVFD crystalloid - Inj Analgetic - Inj Antibiotic - Chest tube insertion with WSDAt the operating theatre : In supine position, aseptic and antiseptic procedure. Infiltration of lidocain 2 % rhomboidly at ICS 5 just anterior to the midaxillary line. Cutis, subcutis was opened sharply, muscle, and pleura paritealis was opened bluntly, sound of air (+). Insertion of chest tube 20 Fr toward cranioposterolateral, and connected to WSD, initial bubble (+), undulation (+) Fixated with silk material Operation was done