A 33 year old woman is BIBA (brought in by ambulance) for hypovolemic shock. You note a significant ascites, hyponatremia, hyperkalemia, and pleural effusion. She says, "I've been trying to get pregnant." You get an ultrasound:
It might look like PCOS (polycystic ovarian syndrome) but your attending suggests it is something more serious.Challenge: What does your attending think?
Related Question:
1. How does wanting to get pregnant fit into this picture?
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Emergency Ultrasound
This is ovarian hyperstimulation syndrome (OHSS) due to gonadotropin therapy for induction of ovulation. It involves the development, luteinization, and ovulation of multiple follicles. OHSS refers to the combination of ovarian enlargement due to multiple ovarian cysts and an acute fluid shift into the intravascular space. It is potentially life-threatening. The best treatment is primary prevention.
Sources: UpToDate; www.smbs.buffalo.edu.
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