Hemothorax is a rare de novo presentation of Ewing’s sarcoma, which is a common malignancy of bones in children and young adults with a male predilection. Ewing’s sarcoma can rarely affect extra-skeletal sites including the lung and when this sarcoma arises from extraosseous sites, they are found to have neuroectodermal tissue [3]. The incidence of hemothorax presenting as the first manifestation of Ewing sarcoma is unknown, as there are so far, to our knowledge, only a few case reports that have described this phenomenon, of which the majority of cases were reported in children less than 15 years old [1-5]. Here we present the case of a 20 year old female patient who presented with a massive hemothorax leading to hemorrhagic shock as her initial presentation of Ewing’s sarcoma.