A Blow-out

Abstract

A 51-year-old man had symptoms that suggested a pair of common diagnoses, but in fact, a rare phenomenon was at work. He presented to the emergency department with a 5-day history of right-sided flank pain, right-sided lower chest pain, and cough with expectoration of yellow sputum. On review of systems, he reported that he had been experiencing fatigue and decreased urine output for 1 month. He had no history of dysuria, hematuria, or significant medical problems, aside from a previous surgery for peptic ulcer disease 10 years earlier.