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Program

Emergency Medicine

Training Level

Resident PGY 1

Institution

Henry Ford Macomb

Abstract

Chest Pain Cholecystitis. 50 year old male presented to the emergency department with a chief complaint of pleuritic chest pain that has been present for 10 hours, sharp in nature, and worsened with inspiration. Patient’s medical history was remarkable for sarcoidosis, hiatal hernia, GERD, and spondylosis. Of note, patient had 3 catherizations over the last three years with no evidence of coronary artery disease. Patient did not smoke nor use alcohol regularly. Patient’s vital signs were within normal limits and patient was subsequently discharged after NSR EKG, 2 negative troponins, unremarkable CXR, and no abnormalities in basic labs. The patient experienced relief after treatment with Pepcid, Carafate, viscous lidocaine, and Maalox. Patient was given return instructions as well as gastrointestinal follow up. Patient returned 3 days later after undergoing esophagogastroduodenoscopy with findings of erosive gastritis and small hiatal hernia. Patient returned as he was experiencing nausea, vomiting, and abdominal pain. Patient reported fevers as high as 102.7 F with a temperature of 100.6F in the emergency department after taking Tylenol 2 hours prior to presentation. All other vital signs were within normal limits. No abnormalities in LFTs or WBC were noted. Lactic acid was at 1.9. CT abdomen and pelvis was concerning for pericholecystic inflammatory changes concerning for acute cholecystitis. General surgery was consulted and ordered ultrasound of the RUQ which demonstrated gall bladder stones, sludge, and wall thickening. Intravenous antibiotics were started and patient was taken for operative intervention the following morning. The laparoscopic cholecystectomy was significant for an inflamed, friable gall bladder, omental adhesions, and frank purulence. 4 days later, the patient was discharged with no complications. This case explores the atypical presentations of acute cholecystitis as well as speculates the relationship of sarcoidosis with gallbladder etiologies.

Presentation Date

5-2019

Sarcoidosis and Acute Cholecystitis

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