A 54-year-old heavy smoker was admitted with a 2-week history of pleuritic chest pain, cough, shortness of breath and weight loss. He had not improved despite a course of antibiotics from his general practitioner.

He was commenced on intravenous antibiotics for presumed pneumonia based on his chest X-ray, which seemed to show left middle zone opacification (figure 1), and after 2 days, he was discharged with a further oral antibiotic course.