Penetrating trauma to the thorax can be highly lethal, specially due to massive hemorrhage. Controversies may occur concerning initial assessment, resuscitation, the operative incision for each case. The objective of this presentation is to discuss some of these doubts in a real scenario. A 38 year-old man was admitted sustaining a stab wound in the 3rd right intercostal space, near the midclavicular line. He was in shock, and the initial debt after right tube thoracostomy as 700 ml. The thoracotomy was indicated after deterioration of the hemodynamic status. A right posterolateral thoracotomy was carried out. There was a considerable amount of blood in the pleural cavity, and packing was necessary to control the bleeding. A wound in the mediastinal pleura was observed. During the dissection, an active bleeding occurred, which was controlled by compression. This allowed the exposure of the superior vena cava and the right atrium. After the placing of a Satinsky clamp, the vena cava was sutured with polipropilene 5-0. The patient was admitted in the ICU. He developed ARDS and pneumonia, among other complications. He was discharged after 40 days of the operation. In conclusion, controversies still take place in the management of penetrating injuries to the thorax. In this case, the right thoracotomy through the 3rd intercostal space allowed a good exposure of the superior and anterior mediastinum.