56-year-old female with portal vein injury from left-sided PTBD placement. Patient underwent emergent PTBD placement for acute cholangitis. After placement, she had dark blood coming from the biliary drain, with a 20% drop in her hematocrit from baseline. She had hemodynamic instability. It was unclear based on this clinical picture whether the patient had an arterial or venous source of bleeding. Hepatic artery angiogram was followed by pullback cholangiogram. The former showed no signs of arterial injury, even after the biliary drain was removed over a wire. Pullback cholangiogram showed traversal of a left-sided portal vein branch (curved black arrow). White arrow—left hepatic duct; straight black arrow—microcatheter for concurrently performed hepatic artery angiogram. The bleeding was successfully treated with drain upsizing and placement of most proximal side holes more centrally. Common bile duct stones were removed endoscopically, and the drain was removed 7 weeks later. At that time, repeat pullback cholangiogram showed no opacification of the portal vein secondary to epithelialization of the tract.