A clerical check revealed no irregularities and examination of the post transfusion samples showed no evidence of hemolysis. An acute hemolytic transfusion reaction was quickly ruled out. The patient was intubated, ventilated and diuresed. He responded to these interventions with resolution of his symptoms and extubation within 24 hours. Although the sudden onset of dyspnea raises the possibility of transfusion related acute lung injury, the presence of hypertension, jugular venous distension and response to diuretics is highly suggestive of volume overload as the cause of the transfusion reaction. Following a complete investigation, the case was signed out as volume overload.