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Christine S. Lai, MBBS; Robert Ludemann, MD, PhD; Peter G. Devitt, MBBS, MS, FRCS, FRACS; Glyn G. Jamieson, MD, FRCS, FRACS
Author Affiliations: University of Adelaide Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia.

Arch Surg. 2005;140:515.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

INTRODUCTION

A 33-year-old woman had a 4-day history of severe left shoulder and pleuritic chest pain. The pain progressed and became epigastric and associated with vomiting. The patient reported a 2- year history of similar episodes that were not as severe or as prolonged as this episode. At prior evaluations, the patient was told that the diagnosis was irritable bowel syndrome. The patient was visibly anxious, her temperature was 37.8°C, and her pulse rate was 150 beats/min. On physical examination, the patient had reduced air entry in the left lung base and had left upper quadrant abdominal tenderness. Her white blood cell count was 14 800/µL, and her hemoglobin was 12.9 g/dL. Other laboratory test results were normal. A chest x-ray film showed decreased excursion of the left hemithorax but no . . . [Full Text of this Article]

What Is the Diagnosis?



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