CASE PRESENTATION: A 47 year old female with history of hypothyroidism, presents with hemoptysis, estimated to be 2 cups of blood over 2 days. Exam was unremarkable except for rales in the upper zone of the left lung. Chest X-ray was normal. Computed tomographic angiography showed relative lucency of the left upper lobe, ground glass opacity in the rest of the lung, with no visible PE, AV malformation or endobronchial tumor. Bronchial artery angiogram demonstrated normal vascularity bilaterally. She was incidentally noted to have a right femoral vein thrombus during the procedure. She continued to have hemoptysis, and had a bronchoscopy revealing clots in the main airway, with blood oozing from the left upper lobe. Due to the persistent hemoptysis, she underwent a VATS left upper lobectomy. Hemorrhagic changes of the apical segment of the left upper lobe were noted. Pathology showed a hemorrhagic infarct, with sharp demarcation from the normal lung parenchyma, and no evidence of neoplasms, vasculitis or infection. She was diagnosed with a SSPE causing a pulmonary infarction and was started on anticoagulation.