This 58 y/o hispanic longhaul truck driver presented to the ER with shortness of breath, hypoxia and low grade fever. He had just completed a run from Oregon to Bakersfield, CA having traveled through the San Joaquin valley. A CT pulmonary angiogram was performed. Selected images shown above demonstrate pulmonary emboli and a parenchymal infiltrate. A pulmonary angiogram (selected images shown above) confirmed the emboli and acute coccidioidomycosis was confirmed by culture and serologic testing. The patient made an uneventful recovery after therapy for both diseases.