Vertebral artery injuries are rare in stab wound with a reported incidence of 1– 7.4%, because of its protected anatomical location along the vertebral column. Associated vascular injuries can be external jugular veins, internal jugular veins and vertebral vein. Laryngeal, tracheal, oesophageal and cervical spinal injuries are other associated injuries, though incidence is rare. Haemothorax and pneumothorax also occur frequently in association with vertebral artery injury. We herein report a case of intra–operative contralateral pleural injury following an isolated left vertebral artery injury after 48 hours when patient reported for pack removal which was left in situ owing to active bleed of vertebral artery due to stab wound in the neck.