Endocrine Case Report: Right Lower Quadrant Pain

Our latest emergency department case report from Brady Pregerson, MD, features a woman in her mids 30s presenting with 2 days of gradually worsening suprapubic and right lower quadrant pain. Can you determine the correct diagnosis?

History:

A female in her 30’s with no significant PMH other than obesity presents to the emergency department with 2 days of gradually worsening suprapubic and RLQ pain that radiates to the back and is associated with 5 episodes of non-bloody vomiting but no fever, dysuria, diarrhea, or discharge. She denies any other complaints or recent unprotected sex.

Exam:

Vital signs are all normal. The abdomen is soft with diffuse lower abdominal tenderness, which is worse on the right and guarding as well as right CVA tenderness.

Testing:

  • WBC = 11, other blood work negative
  • UA small blood, otherwise negative
  • A pelvic ultrasound shows a 3.5 cm simple right ovarian cyst with good flow and no free fluid
  • A CT scan is shown below

What is the additional diagnosis?