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

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.