(Chest 1991; 100:1447-48) A 79-year-old woman underwent a cholecystectomy for acute cholecystitis. The patient’s postoperative course was complicated by episodes of respiratory distress, congestive heart failure, pneumothorax, sepsis, jaundice, and acute renal failure. She subsequently developed a pneumonic infiltrate in the right lower lobe which slowly regressed, coinciding with general improvement in her physical condition. On the morning of the 21st postoperative day, a narrow-bore nasogastric feeding tube was inserted for nutritional support. Later that evening, the patient complained of pain in the chest and some respiratory difficulty, with tachypnea, wheezing, and hypoxemia. An emergency ventilation/perfusion scan was indeterminate for the presence of pulmonary embolus. A follow-up film of the chest was obtained (Fig 1).