DISCUSSION: PCH is a rare vascular disease caused by inappropriate proliferation of pulmonary capillaries within the lung. Only a few cases exist in the literature. In a series of 37 cases, only 3 were diagnosed by lung biopsy and the rest diagnosed on autopsy or in the explanted lung during lung transplant1. Clinical picture varies depending on the affected lung structures. Prognosis is poor and median survival is 3 years. In our patient, PCH was not part of our differential. We were reasonably convinced of the diagnosis of IPF, and planned for targeted therapy. We questioned if biopsy should not have been pursued given the morbid post-op course. The most serious complication of lung biopsy is mortality within post-op 30 days2. Risks and benefits should be considered when deciding to perform lung biopsy. Targeted therapy for IPF does not require a lung biopsy for diagnosis. Had this patient not received a lung biopsy, radiographic and clinical features were fairly suggestive of IPF, and he might have erroneously been started on the ineffective medication. No definitive treatment is available yet for PCH, except lung transplantation. We started patient on imatinib and will observe treatment response.