Recurrent Chest Pain as the Sole Initial Manifestation of Acute Cholecystitis: A Case Report and Diagnostic Challenge

Acute cholecystitis can present atypically, mimicking acute coronary syndrome (ACS) and leading to diagnostic delays. We report a case of a 49-year-old man with diabetes, hypertension, and dyslipidemia who presented three times over 18 days with episodic chest pain radiating to the neck and back. Serial electrocardiograms and high-sensitivity troponin assays were normal. On the third presentation, he developed epigastric tenderness. A right upper quadrant ultrasound was unremarkable; however, a CT aortogram revealed a 1.7 cm impacted gallstone. A prior normal coronary CT angiogram effectively ruled out significant coronary artery disease. The patient underwent laparoscopic cholecystectomy, confirming acute cholecystitis. This case underscores that biliary pathology should be considered in patients with persistent chest pain and a negative cardiac workup, and cross-sectional imaging is pivotal when ultrasound is inconclusive.