Arteriovenous (AV) fistulas are irregular connections between arteries and veins, and thoracic AV fistulas are rarely identified in clinical practice. We report a case of a 56-year-old female with a history of esophageal adenocarcinoma treated with radiation and resection who presented to the hospital due to hemoptysis. She underwent bronchoscopy revealing a tracheobronchial fistula, and esophagogastroduodenoscopy revealing active arterial bleed. Subsequent angiography uncovered an AV fistula between her right T8 intercostal artery and pulmonary vein with a pseudoaneurysm. She underwent coiling of her T8 and T9 intercostal arteries with resolution of her symptoms.