A 63 yo man with h/o biphenotypic ALL, now Day + 32 from allogeneic SCT, who presents with one week of worsening SOB and two days of a clear productive cough.  The patient states his SOB occured when lying flat, but not with activity.  Also admitted to chest pressure which would come and go in his left chest no related to the SOB.  Sleeps with 3 pillows (no change from baseline), denies PND; admits to a slight increase in lower extremity edema.  Admits to low grade fevers to the 99's and crampy abdominal pain.  Denies chills, night sweats, vomiting, or diarrhea.  Patient also has a history of CMV infection, aspergillus and Leggionare's disease and is on posaconazole.  His CXR showed an opacification of the left basilar lobe and also right upper lobe concerning for pneumonia as well as a small loculated right pleural effusion.