On arrival to our ICU, the patient was sedated and mechanically ventilated. Initial chest radiograph revealed complete opacification of the right hemithorax (Fig 1). Because of the reported findings at flexible bronchoscopy, we elected to proceed immediately with diagnostic and therapeutic rigid bronchoscopy. The patient was brought to the operating room and easily intubated with a 13.2-mm outer diameter rigid bronchoscope. A large fibrin blood clot was seen occluding the right mainstem bronchus. The left-sided airways were grossly normal. The right-sided airways were cleared of clot with no visualized active bleeding. However, a large pulsatile lesion was noted along the medial aspect of the right-upper-lobe carina (online video content). A 50% stenosis of the bronchus intermedius was seen, with adequate patency to the right-middle-lobe and right-lower-lobe airways (Fig 2, top left, A). During the airway exam, a massive bleed ensued from this presumed pseudoaneurysm. With suctioning, instilled epinephrine, mechanical tamponade, and left mainstem rigid intubation, the airway was secured. Oxygenation and hemodynamics were stabilized. The left mainstem and trachea were then cleared of clot. A resultant right mainstem bronchus clot was left in place. The rigid bronchoscope was removed, and under direct laryngoscopy a 9.0-mm endotracheal tube was placed and then guided bronchoscopically into the left mainstem bronchus.