Lower Abdominal Pain in a 30-Year-Old Woman
A 30-year-old woman with no significant past medical history presents to the emergency department (ED) with intermittent nonradiating pain in the lower-left part of her abdomen. The pain started approximately 5 days ago and has been steadily worsening since then. She has also been experiencing fevers. At presentation, the patient describes the pain as "severe" and notes that it increases with any motion. There have been no abnormal urinary symptoms (ie, pain during urination or increased frequency of urination). Additionally, she has not had any changes in her bowel habits, including no constipation or diarrhea. She is married and monogamous, and her last sexual intercourse was 2 weeks ago. She has regular menses, with her last menstrual period occurring approximately 3 weeks ago. There is no vaginal discharge. She has no history of any sexually transmitted diseases. She does not smoke and does not use any illicit substances.
On physical examination, the patient has a temperature of 100.2°F (37.9°C) and a blood pressure of 116/63 mm Hg. The patient is tachycardic at about 120 bpm, but seems to have a regular rhythm. Her respiratory rate is normal at 10 breaths/min. She is clearly uncomfortable but does not appear to be toxic. Except for the noted tachycardia, the cardiac and respiratory examinations are unremarkable. The abdominal examination reveals tenderness in the lower abdomen, specifically in the left lower quadrant, but no rebound or guarding is noted. A pelvic examination is performed that reveals scant blood in the vagina and cervical motion tenderness. An 8-cm mass is palpated in the left adnexa, with marked tenderness. The uterus is tender and normal in size. The right adnexa is tender, but no palpable masses are detected.
Initial laboratory investigations are ordered. A complete blood cell (CBC) count reveals an elevated white blood cell (WBC) count of 13.5 × 103/µL (13.5 × 109/L), a normal hematocrit of 38% (0.38), and platelets of 256 × 103/µL (256 × 109/L). A basic chemistry panel and a coagulation profile are unremarkable. A urine test for beta–human chorionic gonadotropin (beta-HCG) is negative, and the urine analysis is negative for evidence of a urinary tract infection.
Transvaginal and transabdominal pelvic ultrasonography are performed
What is the diagnosis?
Hint: Observe the abnormality in the left adnexa