Objective: Hemothorax is an old malady with clear guidelines of management.However, bleeding located into the chest but outside the parietal pleura recently termed extrapleural hematoma1 still poses critical issues in its management even in expert hands.Methods and Results: Our case is a 63-year-old man who was subjected to insertion of central vein catheter (CVC).The right carotid artery was accidentally penetrated causing serious and huge bleeding into the right chest.The pathognomonic sign of"parietal pleura-fat layer" described by Rashid 19992 in trauma patients was seen in CT scans of the chest, but was not observed due to the common attention obviously drawn by the more common bleeding "hemothorax".Chest tube drainage was ineffective.He was operated on using a transaxillary mini-thoracotomy.Extrapleural massive coagulated blood was evacuated, the redundant thickened parietal pleura was excised, and the chest wall was meticulously examined for any bleeders.The operative and postoperative course was smooth, fast track, and uneventful.Conclusions: We conclude that, the diagnosis and correct management of extrapleural hematoma is yet to be known for several clinicians in spite of their excellent clinical experience.The pathognomonic sign is an ideal tool to make the diagnosis and a modern minimal invasive surgery is to be recommended in huge hematoma.A review of the world literature and an operative video of the current case will be presente.