Fifty-four patients with pneumothoraces were treated by tube thoracostomy. Three of these also suffered from pneumomediastinum, two from pneumopericardium, and one from pneumoperitoneum. Except for 2 pneumomediastina, all of these were drained. A chest drain was inserted after chest radiography or transillumination and/or localization of the extrapulmonary air by fine needle aspiration. The drain was placed surgically at the highest point of air accumulation, after creation of a long subcutaneous tunnel and perforation of the intercostal space by blunt dissection. Pressure upon vital structures by pathological air accumulations was relieved in all cases. On a few occasions a tension pneumothorax redeveloped despite there being a chest tube in place, and new chest tubes had to be inserted. No complications due to the procedure were observed.