<h3>Introduction</h3> Mycotic aortic pseudoaneurysms (MAP) are a rare but often fatal complication of thoracic surgery. Recently, our institution has transitioned to performing all lung transplants on venous-arterial extracorporeal membrane oxygenation (VA-ECMO) support when possible. Reinforcement of aortic cannulation sites with pledgeted sutures is often necessary to control bleeding; however, pledgets could also represent an iatrogenic risk for infection. Here we present a fatal case of MAP at the cannulation site in a lung transplant recipient (LTR). <h3>Case Report</h3> We present a 56-year-old female who underwent bilateral lung transplant for scleroderma-related interstitial lung disease. Two months following transplant, she was admitted with methicillin-resistant staphylococcus aureus bacteremia. Initial echocardiogram was inconclusive for endocarditis and thus she was treated with IV vancomycin for six weeks with clinical improvement. Unfortunately, two months later she presented with recurrent bacteremia. Initial imaging revealed evidence of ascending MAP formation, confirmed by positron emission tomography (Figure 1). She underwent surgical repair with identification of a palpable MAP and pathology consistent with acute and organizing inflammation with microabscess formation. Despite aggressive medical and surgical management, our patient suffered a catastrophic embolic stroke. <h3>Summary</h3> While performing lung transplant on ECMO support has many potential benefits, it is not without risk. Closure of ECMO cannulation sites with pledgets in immunosuppressed patients may lead to the development of an infected MAP and can have devastating consequences. To our knowledge this is the first case of an infected MAP at pledget site in a LTR.