We describe a case of a 84-year old woman who presented with a 9 months history of progressive exertional dyspnoea with occasional productive cough. She was subsequently diagnosed with pulmonary embolism and chronic obstructive pulmonary disease. However despite treatment her dypsnoea had progressed to orthopnoea. In addition, she had a significant past medical history of non-metastatic breast ductal adenocarcinoma diagnosed 19 years ago for which she underwent a right mastectomy as well as being put on tamoxifen for 5 years, she was also diagnosed with tuberculosis 70 years ago. On physical examination, she required 4L of oxygen but was otherwise haemodynamically stable. There were decreased breath sounds at the lung bases bilaterally but more prominent on the right. In addition, the right middle and lower lobes of the lung were dull on percussion. Finally auscultation revealed fine crepitations at the lung bases bilaterally. In terms of investigations her CXR and CT-PE demonstrated a pleural effusion. She then underwent thoracocentesis, pleural biopsy, pleurodesis and right wedge resection. Pathology examination revealed malignant cells stained positive for estrogen receptor (ER), progesterone receptor (PR) and Gross Cystic Disease Fluid Protein-15 (GCDFP15) confirming lymphangitic spread of breast adenorcarcinoma to the lung parenchyma. She was treated with paclitaxel and corticosteroids for palliative purpose.