Arterial thrombosis and Budd–Chiari syndrome are rare conditions in lung cancer patients. We report the case of a 53-year-old woman who presented with respiratory symptoms, lumbar pain, weight and appetite loss, and an x-ray showing a lung nodule and diffuse micro-opacities. She was diagnosed with lung neoplasia with extensive lung, liver, lymph node and bone metastases. After discharge she was readmitted with a respiratory infection, and as her condition deteriorated, computed tomography was performed and revealed ischaemic areas in the spleen and kidney, and venous thrombosis, related to Budd–Chiari syndrome, with hepatic ischaemia. Despite hypocoagulation, her clinical condition deteriorated and she died soon afterwards.