A 13-year-old girl presented with a 6-day history of nausea and diffuse intermittent abdominal pain that was more severe in the right upper quadrant. She also had an intermittent fever with temperatures to 39.4°C and had noted dark urine but no pruritus, icterus, or change in stool color. Two weeks previously, she fell on the stairs at school, but her history was otherwise unremarkable. Family history revealed that her mother, maternal aunt, and maternal grandmother had undergone cholecystectomy, although no reasons for surgery were specified.
On physical examination, her height and weight were at the 25th percentile. She was afebrile and anicteric. Results of pulmonary examination showed decreased breath sounds in the right lung base. Her abdomen was soft but diffusely tender, especially in the right upper quadrant, and the liver was palpable 6 cm below the right costal margin and did not cross the midline. The spleen was impalpable.