LAUSR

A 71-yr-old male with a medical history significant for chronic obstructive pulmonary disease presented to emergency department for worsening cough, right-sided pleuritic chest pain, and dyspnea. This was the patient's third visit to the emergency department in 4 d. The patient was initially treated for chronic obstructive pulmonary disease exacerbation and subsequently evaluated for congestive heart failure. He was ultimately diagnosed with a spontaneous herniation of the lung parenchyma through the chest wall. The patient was transferred to an outside host nation facility for definitive treatment and repair of the chest wall defect. Refractory cough and dyspnea failing to respond to typical treatments should warrant an expanded differential to include the rare etiology of atraumatic spontaneous lung herniation.