Abstract
Two patients presented to the Emergency Department with sepsis and vague localising complaints. Both of them had a new elevation of the right hemidiaphragm on chest radiography and were eventually diagnosed with complicated acute cholecystitis on CT imaging. In both cases, the hemidiaphragmatic elevation could not be explained by mass effect as there was no sizable intra-abdominal collection. One of the patients was initially misdiagnosed with pneumonia, resulting in clinical deterioration due to delay in definitive management. Awareness of this phenomenon is essential to avoid pitfalls in patients with acute cholecystitis, especially for those who do not present in a typical manner.