Case 49-1967

Presentation of Case First admission. A forty-six-year-old man entered the hospital because of pain in the abdomen.One month previously he had a respiratory-tract infection with pleuritic pain, which subsided within a few days. Dull, aching pain in the right lower quadrant of the abdomen developed three weeks before admission, and two days before entry there was the onset of precordial aching pain and palpitation of the heart. There was no history of dyspnea, ankle edema or hypertension. He smoked heavily.On admission a few moist rales were audible at the lung bases. The left border of cardiac dullness . . .