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Lower Abdominal Pain in a 30-Year-Old Woman

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BACKGROUND
A 30-year-old woman with no significant medical history presents with intermittent, nonradiating pain over the left lower quadrant. The pain has persisted for 5 days and is accompanied by fever and occasional vomiting. She describes the pain as severe and increased with any motion but has no missed menses, urinary symptoms, changes in bowel habits, or vaginal discharge. She is married and monogamous, and her last intercourse was 2 weeks ago. She has no history of any sexually transmitted disease.

On examination, the patient is afebrile with a blood pressure of 116/63 mm Hg and tachycardia of about 120 beats per minute. She does not appear toxic, and her other physical findings are unremarkable except for tenderness in the lower abdomen, especially in the left lower quadrant; she has no rebound or guarding. Pelvic examination reveals scant menstrual flow and marked left adnexal tenderness without cervical motion tenderness.

Transvaginal and transabdominal pelvic ultrasonography were performed (see Image).

What is the diagnosis?
Hint
Observe the abnormality in the left adnexa.
Authors: D. Brady Pregerson, MD, Attending Physician, Department of Emergency Medicine, Cedars Sinai Medical Center; author, Quick Essentials: Emergency Medicine and Side-Kick: Emergency Medicine.

eMedicine Editor: Rick Kulkarni, MD, Attending Physician, Department of Emergency Medicine, Olive View - UCLA Medical Center, Assistant Professor of Medicine, David Geffen School of Medicine at UCLA  
     


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