Case of the Month June 2015

Case submitted by Brian Lee, MD, and approved by Thomas J. Learch, MD.

You are the radiologist on call over the weekend. A 31-year-old G1P1 female with a history of polycystic ovarian syndrome (PCOS) comes to the emergency department complaining of severe right-sided pelvic pain that started this morning when she woke up. She notes that she has had this type of pain before. She also has experienced a fever today. In the ED, her beta-HCG is negative, and she has an elevated white blood cell count of 16,000 / uL.

The emergency physician suspects a gynecological cause for the patient’s symptoms.

Per ACR Appropriateness Criteria as of 2015, which of the following is the most appropriate exam for acute pelvic pain?

1) Abdominal radiograph
2) Pelvic ultrasound
3) CT Abdomen/pelvis
4) MRI pelvis

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