CASE PRESENTATION: An 81-year-old Caucasian male with history of giant cell arteritis, diabetes, hypertension and asbestos exposure presented to his primary care physician for follow up for the workup of anemia after complaining of shortness of breath for the past few months. While in the physician’s office, the patient experienced sudden back pain, loss of consciousness, and seizure-like activity. The episode lasted 1-2 minutes with the patient regaining consciousness. The patient was then immediately sent to our facility. Upon arrival, vital signs were stable, and complete blood count and complete metabolic panel were within normal limits. Physical exam was benign aside from decreased breath sounds in the left lower lung field. Initial chest x-ray showed a large opacity in the left lower lobe. CT angiogram of chest was done in the emergency room, which revealed a mediastinal hematoma, moderate to large left suspected hemothorax with an intact aorta and no evidence of dissection or aneurysmal formation. The patient denied any previous history of malignancy or trauma of any sort. Cardiothoracic surgery was consulted and the patient underwent left video-assisted thoracoscopic surgery (VATS) with drainage of the hemothorax, left parietal pleural biopsy, and subsequent chest tube placement. There were no appreciated signs of bleeding or etiology of his bleed seen on VATS. Approximately 1740 cc of blood was drained with no complications. Biopsy results showed fibro-adipose tissue, with no evidence of malignancy.