A 83 years old man was admitted to acute medical unit for mild asthma exacerbation. He also had atrial fibrillation and was on dabigatran. A mass on left upper chest wall was incidentally found. There were bruises over left posterolateral aspect of chest wall. Chest X-ray showed left pleural effusion. Diagnostic tap yielded blood-stained fluid. Computer tomography showed left lung herniation. Cardiothoracic surgery team unit was consulted. Reduction of lung herniation and patch repair of chest wall defect was done.