Primary tension hemopneumothorax is a life threatening condition rarely encountered nowadays. This entity is defined as the accumulation of more than 400 mL of blood in pleural cavity associated with spontaneous pneumothorax in a previously healthy patient with no underlying lung disease. We described a case report of a young gentleman presenting with progressive worsening of breathlessness and chest pain associated with tachycardia and tachypnea to Emergency & Trauma Department, Hospital Sultanah Aminah Johor Bahru, Johor. Initial hemodynamic status was stable. Initial diagnosis of right spontaneous tension pneumothorax suggested by clinical findings and confirmed by radiographic findings was soon revealed to be a right spontaneous tension hemopneumothorax due to persistent hemoserous drainage after tube thoracostomy. He was then subject for right thoracotomy due to persistent bleeding and torn vascularized bullae was found to be the source of the bleeding intraoperatively. He was discharged without any complication after 9 days of hospital admission. We also performed electronic searches on PubMed, Medline and a general web search using Google scholar to review any literatures in relation to this rare clinical situation and their clinical presentations, possible causes and effective treatment modalities.