Dr. Stanley P. Bohrer: A 22-year-old professional prize fighter entered the emergency ward of the Massachusetts General Hospital with a history of sharp right upper quadrant pain that had continued for 36 hours. He denied recent trauma. Eight hours after its onset the pain began to radiate into his right chest and with deep inspiration radiated to his right shoulder. At this time severe hiccoughs developed as well as a low-grade fever.
Prior to this illness he had been in good health. A chest x-ray film taken 7 years prior to this admission was reported as negative. His father died at age 54 of tuberculosis.
On admission he was tachypneic, breathing 32 times per minute. His blood pressure and pulse were normal. His temperature was 101 F ( 38.33 C ). He had slight right upper quadrant tenderness. Initially, his chest was reported as clear. Later, a consultant reported some dullness at the right lung base. His breathing was very shallow and he complained of pain with