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History A 42 year old black male presented with the complaints of upper abdominal pain and shortness of breath. He had previous hospitalizations for alcoholism and pancreatitis. Physical examination revealed a cachectic man with BP 110170 mm Hg; temperature 37 .2 °C; respiration 18/min; and pulse 80/min. Lung fields were clear except for diminished breath sounds in the right base. Abdominal examination was unremarkable. White blood ceU count was 8200/cu mm with 680Jo

Diagnostic Challenge: Dyspnea and Abdominal Pain in an Alcoholic