Case 40351

Presentation of Case First admission. A sixty-six-year-old housewife was admitted to the hospital because of abdominal pain.Thirty-six hours previously severe right-upper-quadrant pain had suddenly begun, radiating around the right costal margin to the back. She denied chills and fever but had vomited once.The past history revealed that six months before admission she had palpitations and "skipping heart," with moderate dyspnea on climbing three flights. She was given 1 tablet of digitalis every day until three days before admission. There was no ankle edema, nocturnal dyspnea, known hypertension or diabetes. She had lost 20 pounds gradually over the past . . .