History of Present Illness

A 52-year-old woman presents to the emergency department with bloating and right-sided chest/rib pain that radiates to her back and epigastric area. She notes that the bloating started approximately 8 hours prior and denies any trouble breathing or experiencing fever, cough, vomiting, diarrhea, or other complaints. She has never experienced this type of pain before.

Vital Signs and  Physical Examination

The patient’s vital signs are normal including bilateral blood pressure; however, her temperature is 99.2 °F. Physical examination is normal except for right upper quadrant (RUQ) tenderness with guarding. Pulses in the arms and legs are symmetric and there is no leg swelling or tenderness.

Initial diagnostic test reveals a normal complete blood count (CBC) without shift, liver function test (LFT), and urinalysis. Cardiology workup includes a normal electrocardiogram and troponin levels. A chest radiograph is normal and a chest ultrasound is taken (Figure).

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