Adenoid cystic carcinoma (ACC) is one of the most common malig-nancy in secretory glands. It accounts for about 15% -25% of all malignant salivary gland carcinomas. Typically, ACC is slow growing tumors and develops distant metastasis via haematogenous. We report a case who presented with respiratory failure and multiple metastases. A 52-year-old male, underwent a radical craniofacial resection for a right parotid gland, followed by postoperative radiotherapy. He was followed-up with head CT scans for 5 years with no signs of locoregional recurrence. Physical examination was normal. Blood gases analyses showed moderate hypoxemia. pH; 7,49 pCO2; 31,8 Po2; 38,9 HCO3; 24,1 sat O2; 79,1. Thorax CT showed multiple lesions ranging in size from 5 mm to 4 cm distributed diffusely in both lungs. CT-guided fine-needle aspiration of the lung lesion was performed. Pathological analysis reported adenoid cystic carcinoma. Multiple pulmonary metastases may cause respiratory failure and requires constant vigilance by medical practitioners.