CASE PRESENTATION: 70 year old lady was admitted with cough and fever. Her past medical history was significant for recurrent bacterial bronchitis, chronic rhinosinusitis, esophageal dysmotility with microaspiration, seronegative arthritis and asthma. No history of bleeding disorder, antiplatelt, anticoagulation therapyor tobacco use. On admission physical exam was remarkable for temperature 102.6 Fahrenheit and bilateral scattered harsh breath sounds. White cell count was 12.8 thousand , platelet count was 190, INR was 1.08. She was empirically started on IV antibiotics for bronchitis pending culture results. On day 6 of hospitalization, she developed sudden onset right sided excruciating pleuritic chest pain. Physical exam revealed reduced breath sounds right lower chest. Chest x ray showed new onset right lower zone haziness. CT scan showed right hemothorax as evident by extravasation of contrast material into the pleural space (most likely from the intercostal branches of the right main bronchial artery). Her clinical status rapidly deteriorated with acute drop in hemoglobin from 11.3 to 8.2 gram requiring ICU transfer and emergent chest tube palcement for tension hemomthorax. 1.5 liters of frank blood was drained and was transfused packed red cells. She underwent right Video Assisted Thoracoscopy with evacuation of hematoma and partial decortication. Erythema and red sanguineous oozing was noted in the posterior apical hemithorax just superior to the azygos vein which was coagulated using electrocautery.