Here is a fun case for the 50% of you who are still reading your own plain films after hours (me too!). An elderly gentleman arrives with a dry cough and shortness of breath for several days. Family reports him to be “a little confused.” There is no history of trauma.

Vitals show P 65, RR 24, sat 93% RA, BP 145/68, Temp 37.3 C. He has a history of coronary angioplasty, and is taking metoprolol 50mg daily.You round up the usual suspects: possible pneumonia or PE, rule out cardiac ischemia or CHF. ABG shows a PaO2 of 62 mmHg. Labs are pending, and a chest X-ray is shown below. You request admission from the hospitalist, who in turn requests a CT scan to “rule out PE.”