CASE PRESENTATION: 55 y/o female initially seen at an outpatient clinic with productive cough of dark colored mucus, chills, and sweats for 1 week. She was a 40 pack-year smoker with remote history of hysterectomy. She was seen as an outpatient 3 times over 6 weeks, by 3 different physicians, for persistent symptoms despite treatment for a diagnosis of bronchitis then asthma despite no prior history of asthma and functional testing. None of the 3 physicians were her actual primary care doctor and one of these visits was to an urgent care clinic that didn’t have access to previous medical records. There was a clear chest x-ray on the initial visit and a reportedly normal chest x-ray at the urgent care clinic visit with no report of objective findings on physical exam at any visit. 8 weeks after the initial appointment, an x-ray at another primary care appointment showed small bilateral pulmonary nodules prompting further evaluation. Repeat chest x-ray one week later showed marked increase in size and number of bilateral pulmonary nodules. Over the next 3 weeks, the patient failed to return for subsequent scheduled appointments and was admitted to the hospital for expedited evaluation after later returning to the pulmonology clinic with worsening symptoms. On admission numerous, bilateral, pulmonary cannonball lesions and an elevated B-Hcg were found. Biopsy of these lesions showed choriocarcinoma. Comprehensive imaging to include a PET showed no other primary lesions. Chemotherapy treatment was started with subsequent decrease in her B-Hcg. Despite this treatment and initial improvement, she developed neurological symptoms and was found to have metastasis to her brain. She requested palliative treatment and hospice.