Girl With Chest Pain

A 13-year-old girl presented to the emergency department with sharp left upper quadrant abdominal pain, irradiating to the back and worsening with deep breathing or reclining. The pain had arisen suddenly 2 days before while she was swimming and was accompanied by low-grade fever (37.5°C [99.5° F]) and mild cough. Physical examination was remarkable for dullness and decreased breath sounds at the left lung base. Laboratory tests showed neutrophilic leukocytosis and elevated c-reactive protein level.

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