CASE PRESENTATION: A 77 year-old female presented to the emergency room with persistent shortness of breath and cough productive of green sputum. She has a history of Hepatitis C-related hepatocellular carcinoma (HCC) and had underwent radiofrequency ablation (RFA) followed by wedge resection years prior to admission. After experiencing HCC recurrence, she underwent a transarterial chemoembolization (TACE) with Yttrium-90 (Y90) and adjunctive RFA. Of note, she was treated in the preceding two weeks for community-acquired pneumonia without improvement in symptoms. Concern for delayed healthcare-associated pneumonia prompted expanded antibiotic therapy. Despite several days of therapy she failed to improve which prompted further work-up. During bronchoscopy copious bright green-tinged sputum was found originating from the right lower lobe. Bronchoalveolar lavage was culture negative for pathogenic microbes, but urine dipstick confirmed the presence of bile. A hepatobiliary iminodiacetic acid (HIDA) scan confirmed fistulization of the right lobe of the liver with the right lower lobe of the lung. Ultimately, she underwent endoscopic retrograde cholangiopancreatography (ERCP) with biliary stent placement. Despite the ERCP, she had no change in the quality or quantity of bilious sputum produced. Her fistula was ultimately sealed with a microvascular plug and multiple interlocking detachable coil embolizations to the fistula followed by repeat cyanoacrylate / ethiodized oil glue sealing.