Wednesday, September 23, 2009

Horse

A G1P0 woman at 10 weeks gestation presents with right lower quadrant abdominal pain. She also has some nausea and vomiting, worse than her normal "morning sickness." She's lost her appetite, complains of general malaise, and has fevers and chills. On exam, palpation of the left lower quadrant causes pain in the right lower quadrant. Her WBC count is 15,000. You order an MR, and a T2 weighted image is shown below. The pathology is noted by the arrow. GS refers to the gestational sac.

Challenge: What's your diagnosis?

Image shown under fair use.

1 comment:

Craig Chen said...

Horse

This is acute appendicitis, the most common general surgery problem in pregnancy. The classic presentation of periumbilical pain migrating to the McBurney's point only occurs in 50-60% of patients. Rovsing's sign is RLQ pain upon palpation of the LLQ. The psoas sign is pain with extension of the right hip, and the obturator sign is pain with internal rotation of the hip.

Source: UpToDate, original image from Deborah Levine.