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We must congratulate Dr Whitaker and his team for correctly diagnosing a tension pneumothorax and saving the patient’s life with subsequent needle thoracocentesis (November 2003 JRSM1). The tension had arisen 32 hours after a diagnostic fine needle aspiration (FNA) of the left upper outer quadrant of the breast. However, we disagree that the ensuing haemothorax was caused by the FNA and feel it was far more likely to be caused by the needle thoracocentesis. At operation the lesion was found to be at the apex of the lung which in the normal lung lies above the clavicle, higher than where the FNA was performed. Needle thoracocentesis for a tension pneumothorax at the 2nd intercostal space midclavicular line is much more likely to hit the apex of the lung and cause haemothorax.