A 56-year-old African-American man presented to the emergency department with mild chest pain and otalgia. He also noted a nonproductive cough of several days’ duration and mild back pain. He denied the presence of any fever, chills, or hemoptysis. His medical history was remarkable for homozygous sickle cell disease with multiple complications, including a cerebrovascular accident in September 1999 with resultant hemiparesis as well as peptic ulcer disease. The patient had a long history of hypertension, which was controlled by medication. He reported having undergone multiple blood transfusions, but none in the last 2 years. He denied any recent sickle cell crises.