Read the full case description. What is the diagnosis? What diagnostic test is most likely to be helpful? Cast your vote on the diagnosis and submit a comment about what diagnostic test is indicated. The correct diagnosis, along with the full description of the case and the procedures performed, will be published as the Case Records of the Massachusetts General Hospital in the March 28 issue of NEJM, live on NEJM.org at 5 PM ET Wednesday, March 27. Check NEJM.org starting at 5 PM ET Wednesday to see if you were correct.