CASE PRESENTATION: A 54-year-old non-smoking lady underwent a cardiac computed tomography scan for coronary calcium for evaluation of chest pain, which found mutiple sub-centimeter pulmonary nodules present in both lungs. She underwent total hysterectomy 15 years ago for menorrhagia secondary to fibroids. Physical examination was unremarkable. Computed tomography of the chest (Panel A), abdomen and pelvis showed no evidence of a primary malignant neoplasm. The patient underwent a video-assisted thoracoscopic wedge resection of the right middle and lower lobes, which showed multiple small circumscribed firm whitish nodules (Panel B). Histologic findings showed proliferation of interlacing fascicles of bland spindle cells (Panel C), accompanied by a few entrapped tubules. Immunohistochemical staining was positive for smooth muscle marker caldesmon and estrogen receptors (Panels D, E). Other differentials including leiomyosarcoma and lymphangioleiomyomatosis were excluded and she was diagnosed with BML. No further treatment was given but the patient remained on surveillance for disease progression.