We discussed a 20 year old female with a history of pediatric ALL (in remission for 15 years s/p chemo, no radiation) who presented to the ED with nausea and “throwing up blood” which started 1 hour before presentation. She reports lightheadedness morning of presentation and then had 5-6 episodes of emesis over an hour. At the end she noted blood clots. She had been doing well, except about 4 weeks prior to this episode she was seen for shortness of breath, cough and fever and given albuterol, azithromycin and prednisone. 4 months prior she was started on famotidine for GERD. N She had a splenectomy 10 years prior to admission for pancytopenia though to be due to sequestration. No significant family history. After extensive work up she was diagnosed with non-cirrhotic portal hypertension secondary to a chronic portal vein thrombosis thought to be due to her depo injections which were discontinued.