Subclavian catheters were used in the treatment of chronic renal failure patients waiting for the maturation of AV fistula. But, it sometimes causes fatal complications. Of these, massive bleeding into pleural cavity after subclavian vein cannulation is a rather rare but causes very serious complication. Most of patients with hemothorax are successfully treated with conservative treatment(i.e. pleural drainage, maintaining the circulatory volume, treatment of possible coagulopathy) but it sometimes needs surgery. We recently experienced a case of ARDS complicated by hemothorax which was successfully treated with thracooscopic drainage. We reviewed the pathogenesis of ARDS by hemothorax and suggested the guidlines for the treatment of massive hemothorax using video-assisted thoracoscopic surgery.