[A patient complaining of right hypochondralgia with back pain. Aortic dissection or cholelithiasis?]

A 70-year-old woman with a past history of cholecystolithiasis was admitted to a local clinic because of right hypochondralgia with back pain. Since physical examination revealed Murphy's sign, this patient was diagnosed as acute cholecystitis. The ultrasonographic examination of the gallbladder showed a stone of the cystic duct with no definitive wall thickening. CT scan revealed dissection of the abdominal aorta. She was then referred to our hospital for further examinations. She was observed in the cardiac care unit to determine whether the aneurysm and cholecystitis were in an acute or chronic state. Blood examinations and enhanced CT scan showed that her clinical symptoms originated not from cholelithiasis but from acute closing aortic dissection, Stanford classification type B. Close cooperation with a highly developed medical facility is essential when diagnosing elderly patients with symptoms open to a variety of interpretation.