Monday, January 2, 2012


A 30 year old woman reports sudden intense right lower quadrant abdominal pain after going to the gym. This pain was also accompanied by some light vaginal discharge. She presented to urgent care where she had normal vital signs. Physical exam showed moderate tenderness to palpation on the right lower quadrant with minimal rebound and guarding. Pelvic exam showed mild cervical motion tenderness and slight adnexal fullness. Laboratory studies are normal and a pregnancy test is negative. Urinalysis shows pyuria. A CT abdomen/pelvis is shown below.

Challenge: Lots of things present this way; what is your diagnosis?

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Anonymous said...

Fitz-hugh-curtis syndrome (perihepatitis)?

Craig Chen said...

good guess, esp. with the perihepatic junk.

This is a ruptured ovarian cyst. The first CT scan shows blood in the abdomen, and the second shows a poorly defined adnexal mass.

Source: UpToDate.