The development of a right hemothorax as the result of a ruptured thoracoabdominal aneurysm is an uncommon and usually fatal event. Survival depends upon an accurate diagnosis and prompt surgical intervention. We present a case of a ruptured thoracoabdominal aneurysm into the right chest that presented as opacification of the right hemithorax and hypotension. An early CT scan provided the correct preoperative diagnosis, although the patient did not survive.