History A 45-year-old man presented to a community hospital emergency department at 1:00 am with mid-epigastric pain that began at midnight, shortly after eating a meal. He had experienced the same pain each of the previous two nights, and, in each case, the pain disappeared by morning. He reported no nausea or vomiting and no change in his bowel habits. He was afebrile, and no jaundice was seen. However, the patient was diaphoretic, and he experienced mild shortness of breath when the pain was present. Blood analysis revealed elevated liver enzyme levels: serum alanine aminotransferase was 369 U/L (normal range, 21–72 U/L), serum aspartate aminotransferase was 293 U/L (normal range, 17–59 U/L), and serum γ-glutamyltransferase was 433 U/L (normal range, 15–73 U/L). Total bilirubin, serum alkaline phosphatase, amylase, and lipase levels were normal. His white blood cell count was normal, at 5.8 × 109/L (normal range, 4.0–10.0 × 109/L). A provisional diagnosis of acute cholecystitis was made, and the patient was instructed to return to the hospital the next morning for abdominal ultrasonography (US). His medical history was remarkable only for a 2 × 1-cm pigmented cutaneous lesion on the left upper abdomen that was excised 5 days after he presented to the emergency department. Excisional biopsy revealed that it was a completely regressed melanocytic lesion. Best Cases from the AFIP