The patient presented with the above chest x-ray findings of areas of bilateral consolidation. A repeat chest x-ray (not shown) after 18 days of treatment was identical. Suspicion of other pathology necessitated further assessment with CT imaging which was done 28 days after presentation. 

Subsequent biopsy proved multifocal adenocarcinoma.

This case reinforces the necessity to follow up such cases until resolution occurs. In appropriate cases, and to ensure referrer compliance, the report might well read, "Follow-up imaging is recommended in order to exclude underlying neoplasia."