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Constant Dull Abdominal Pain in a 35-year-old Woman


The woman reported no other abdominal or gastrointestinal symptoms; menses were regular; a pregnancy test was negative. What next?

[[{"type":"media","view_mode":"media_crop","fid":"39877","attributes":{"alt":"Ovarian hyperstimulation syndrome","class":"media-image media-image-right","id":"media_crop_7386847485762","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4020","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 259px; width: 335px; float: right;","title":"Figure 1.","typeof":"foaf:Image"}}]]A 35-year-old woman presented to her primary care physician’s office with constant dull pain in the lower abdomen of one month’s duration. There was no history of fever, nausea, vomiting, diarrhea, constipation, or weight loss. Her menstrual cycles were regular. She had been receiving treatment for infertility for last 18 months. On physical examination, she had mild tenderness in the lower abdomen and pelvis. The rest of the physical examination was normal. A pregnancy test came back negative. [[{"type":"media","view_mode":"media_crop","fid":"39878","attributes":{"alt":"Ovarian hyperstimulation syndrome ","class":"media-image media-image-right","id":"media_crop_8997417583237","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4021","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 259px; width: 335px; float: right;","title":"Figure 2","typeof":"foaf:Image"}}]]Routine blood tests were obtained and results were within normal range. An ultrasound of the pelvis was ordered; findings are presented in the Figures 1 and 2. 

What do the ultrasound images reveal?

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