Thursday, January 26, 2012


A 22 year old woman comes into clinic complaining of lower abdominal pain, worse with jarring movements, which started just after her period finished. It's been going on for a week. The pain does not localize to any particular side. The patient also has some fevers, chills, and vaginal discharge. She denies nausea, vomiting, diarrhea, dysuria, or change in bowel habits. The patient has multiple sexual partners and uses an oral contraceptive. She has no past medical or surgical history.

On exam, the patient is afebrile. Abdominal exam shows tenderness in the lower quadrants with rebound. Bowel sounds are diminished. Pelvic exam shows endocervical discharge, adnexal tenderness, and cervical motion tenderness. The pain and tenderness do not lateralize to any side.

Ultrasound is shown below:

The ovary is marked OV and the arrows point to the Fallopian tube.

Challenge: What's your diagnosis?

Image shown under Fair Use.


Reflex Hammer said...

Ectopic pregnancy?

Anonymous said...

PID --> pelvic peritonitis/tubo-ovarian abscess?

Craig Chen said...

yep - PID

This is pelvic inflammatory disease. Ultrasound shows a thickened Fallopian tube.

Sources: UpToDate;