CASE PRESENTATION: 57-year-old male with past medical history of hypertension, former smoking, and moderate COPD, was admitted with chief complaint of severe cough for 4 days. His cough was associated with mild shortness of breath, yellowish sputum production and left sided pleuritic chest pain. On presentation, vitals were significant for hypertension (151/91), tachycardia (151), and hypoxia (91%) on room air. Physical exam revealed an obese male in mild distress, prominent wheeze, rales bilaterally, associated with chest wall tenderness on palpation and decreased breath sounds in the left lung base. Initial laboratory findings revealed: leukocytosis (14.4) and mild renal insufficiency (Cr: 1.5). ABG showed hypoxia with respiratory alkalosis. CXR showed hyper-inflated lungs with possible left lower lobe infiltrates. The patient was started on IV steroids, antibiotics, bronchodilators, and pain medication. CT imaging revealed, a lung hernia (4 cm anteroposterior X 2.8 cm craniocaudally X 2 cm protrusion) postero-laterally on the left, between the left eighth and ninth rib. Thoracic surgery was consulted, but decision was made to treat medically. Findings have been the cause of patient’s chest wall pain, but were unlikely related to patient's respiratory symptoms. After close observation, cough subsided and chest wall pain improved with treatment of pneumonia and cough suppressant. The patient was followed as an outpatient at months 1 and 4 post discharge. Symptoms had resolved and CT chest findings were unchanged.