One axiom that we teach medical students is that “common things are always common” and physicians who make common diagnosis are almost always correct. However, it is also important to keep a watchful eye to identify rare diseases so that a timely diagnosis is made for the patient's benefit and that a disease is identified before it becomes too late. Presented here is a rare case of pleural angiosarcoma in a young male presenting as pleural effusion who was initially thought to have tuberculosis pleural effusion.