An 85-year-old female, previously demented and dependent on others, presented to the emergency department with sudden dyspnoea following a coughing paroxysm. She was polypneic and had a diminished vesicular murmur at pulmonary auscultation but with audible bowel sounds in the right hemithorax. Arterial blood gases showed hypoxemic respiratory failure, but the additional blood work was unremarkable. A thoracic radiograph and computed tomography were done.
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