An abdominal aortic or iliac artery rupture typically presents with central abdominal and back pain, collapse and shock. In this article, we present a very rare case of massive bilateral hemothorax associated with ruptured iliac artery aneurysm. While ruptured iliac artery aneurysm was treated with an emergent endovascular intervention, bilateral tube thoracostomy was performed for hemothorax. The patient was discharged from hospital at the 10th postoperative day in a good condition. At six-months of follow-up, tomographic scan was normal with a reduction in the aneurysm size.