CASE PRESENTATION: A 93-year-old woman developed small bowel obstruction two days after undergoing an elective repair of right inguinal hernia. Exploratory laparotomy revealed adhesions posterior to the mesh repair of hernia, which were lysed. The patient's medical history included Hypertension, Coronary Artery Disease, Hypothyroidism, and GERD. TPN was initiated peri-operatively through PICC in the left arm. The patient developed shortness of breath gradually after two days. She was afebrile with stable vital signs. Chest examination showed decreased breath sounds bilaterally at the bases posteriorly. Abdominal exam showed diffuse mild tenderness to palpation without peritoneal signs, and diminished bowel sounds. Laboratory studies were normal except for an elevated WBC count of 14 K/mL. Chest X ray showed large bilateral pleural effusions [Fig.1]. Left sided thoracentesis was performed which showed chylous fluid chemically similar to TPN preparation, with normal pathology and microbiology studies. 1.8 liter of fluid was removed with resolution of symptoms. Computed tomography (CT) with injection of contrast through the PICC line showed obvious extravasation of TPN fluid and contrast into the pericardial and pleural space [Fig.2]. The PICC was removed and there was no recurrence of pleural effusions.