A 35-year-old woman with a history of endometriosis and fibroids presents to the emergency department for 3 weeks of lower abdominal pain that suddenly got much worse today around 9 AM. The pain is aggravated by walking or other movement. She denies any fever, vomiting, dysuria, vaginal bleeding, or other complaints
The patient is noted to be in moderate distress with normal vital signs including her temperature. Examinations of the head and neck as well as the chest are normal. On abdominal exam there is rebound tenderness noted throughout the lower abdomen. Pelvic exam shows no bleeding or discharge.
• Blood chemistries, LFTs, lipase: normal
• Beta hCG: negative
• CBC: WBC 30,000/uL hemoglobin, 11 g/dL
• ESR: 70 mm/h
• CT scan pelvis: (click on Image to the right to enlarge)
What does the CT image show?
What conditions should be in your differential diagnosis?
Please click below for answers and discussion.