The chest x-ray of a 47-year-old man showed a large density in the left lung and malignancy was suspected. Tc-99m MIBI lung imaging showed a photopenic area in the lower two thirds of the left lung. Lung perfusion scintigraphy with Tc-99m MAA performed before MIBI lung imaging showed a large perfusion defect in the lower two thirds of the left lung. CT showed a large cystic area in the left lung, bronchoscopy and bronchography showed displacement of the left sided bronchioles by the enormous cystic formation. Surgery showed organized intrapleural and pulmonary hematomas possibly caused by a prior thoracic injury or spontaneous rupture of an emphysematous bleb.