-A 70 years-old, male, smoker

-5 days before presentation, he sought medical advice for dyspnea, coughing, expectoration and decrease of urine output

-Laboratory tests were done then revealing T.L.C.:22.000 c/mm³, s.creatinine: 4.2 mg/dl, s.urea: 253 mg/dl

-So, he presented to us for renal impairment management

-On physical examination:

                    -no air entry on the left side

                    -noticeably, the patient wasn't bothered with this situation, sitting calmly waiting to finish C.T. chest examination!

-Unfortunately, the patient progressed rapidly to a cardiopulmonary impending arrest

-Rapid management and with fixation of a chest tube, the attending physician described a loud air-blowing sound (described it as the sound of tyre blowout), and dispersion of odorous pus allover the surroundings (pus under tension)!

-Of course, this was a case of tension pyo-pneumothorax causing septicemia with all of its sequelae; leukocytosis, renal impairment and even impending cardiopulmonary arrest

-Strikingly, this old man was not agonized or complaining like we expect in such critical cases, till collapsing all of a sudden. So, we have to recognize that even complaining requires intact mental and physical status, which may be defective in certain age-groups, so don't wait for the typical presentation in these patients' groups, and behave promptly according to the patient's status