CASE PRESENTATION: A 34-year-old man with history of b-thalassemia major and splenectomy presented with a 1-month history of progressively worsening dyspnea, orthopnea, localized chest discomfort, and lower extremity edema. He denied fevers, chills, nasal congestion, and night sweats. He denied tobacco, alcohol, and illicit substance abuse. Family history was remarkable for lung cancer in his mother.