Transfusion-related acute lung injury (TRALI) is a rare complication of blood transfusion that causes acute lung injury within 6 hours of transfusion. It is difficult to diagnose due to a lack of clear defining features. TRALI is characterized by acute respiratory distress, hypoxemia, bilateral lung infiltrates on chest imaging, and no evidence of circulatory overload. Transfusion-associated circulatory overload (TACO) presents similarly but is caused by an excessive fluid volume from transfusion that leads to pulmonary edema. Differentiating between TRALI and TACO can be challenging and requires considering factors like fever, blood pressure, fluid balance, and cardiac function.