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Transfusion-related acute lung injury (TRALI) is the second leading cause of transfusion-associated mortality in high-risk patients undergoing major surgery. TRALI presenting with acute hypoxia and non-cardiac edema is a vital clinical entity which must be considered in the differential diagnosis in transfusion-associated patients. Fresh frozen plasma, erythrocyte suspension and thrombocyte suspension transfusion were performed during perioperative and postoperative periods to the patient undergoing supracoronary graft interposition due to ascending aortic aneurysm. Respiratory support treatment with positive pressure mechanical ventilation was initiated for acute hypoxia and bilateral pulmonary edema developed immediately after the procedure. The patient thought to have delayed TRALI was extubated on postoperative 5. day. Noninvasive mechanical respiratory support treatment was maintained. On postoperative 10. day the patient did not need any oxygen and ventilatory support. TRALI should be considered in patients with acute onset of hypoxia, ARDS especially in cases undergoing major surgery and transfusion of large amounts of ES, FFP, platelet suspension. Noninvasive mechanical ventilation should be considered as a treatment option. [ABSTRACT FROM AUTHOR]