Stent placement is an accepted primary treatment for SVC syndrome. Balloon dilation is frequently performed prior to stent placement. Although various stent-related hemorrhagic complications have been reported, as well as reports of iatrogenic catheter and guidewire perforations, there has been only one previous report of balloon dilation-related SVC rupture. We report a second case, including the clinical scenario, in the hope that should this complication occur, it might be recognized quickly and treated successfully.