# Biliary Dyskinesia Presenting as Atypical Chest Pain: A Case Report

## TL;DR

A 58-year-old man with diabetes presented with chest pain mimicking a heart issue, but was diagnosed with biliary dyskinesia after further tests.

## Contribution

This case report highlights biliary dyskinesia presenting atypically as chest pain, emphasizing the need for broad differential diagnosis.

## Key findings

- The patient's chest pain was found to be caused by biliary dyskinesia with a gallbladder ejection fraction of 19%.
- Cardiac evaluations were negative, but CT imaging revealed gallstones leading to the correct diagnosis.
- The case underscores the importance of considering biliary pathology when cardiac evaluations are inconclusive.

## Abstract

Biliary dyskinesia typically presents with right upper quadrant or epigastric pain, but we describe an atypical case in a 58-year-old man with diabetes who presented with left-sided chest pain radiating to his left arm. His presentation initially suggested a cardiac etiology; however, cardiac evaluation, including stress testing and serial troponins, was negative. CT imaging incidentally revealed gallstones, prompting further investigation. Hepatobiliary scintigraphy subsequently confirmed biliary dyskinesia with a reduced gallbladder ejection fraction of 19%. Although surgical management was recommended, the patient elected to defer cholecystectomy and continue outpatient follow-up. This case highlights the importance of maintaining a broad differential diagnosis when standard evaluations are unrevealing, as biliary pathology may mimic cardiac symptoms.