BACKGROUND
A 28-year-old woman from Bosnia presents to the hospital with a 2-day prodrome of a cough with scant brown sputum, malaise, mild headache, and chills for which she is given erythromycin. Last night, pain developed in the middle and right lower quadrant of her abdomen. She has a medical history of infertility and no surgical history. Her vital signs are as follows: temperature, 100.1°F (37.9°C); heart rate, 80 beats per minute; blood pressure, 110 mm Hg systolic, 70 mm Hg diastolic; respiratory rate, 28 breaths per minute. The patient is alert and shows no signs of toxicity; her sclerae are anicteric. Her lungs are clear. The patient's abdomen is soft and flat but mildly tender in the middle and right lower quadrant. She has no signs of rebound pain or guarding. No mass is present, and her bowel sounds are normal. Her pelvic examination reveals a normal cervix, no discharge via os, no cervical motion tenderness (CMT), and mild right adnexal tenderness but no mass. Her rectal tone is normal, no mass is present, and the rectum is nontender. Abdominal CT with oral and intravenous contrast enhancement was performed. Among her laboratory findings, the white blood cell (WBC) count is 2100 per microliter; the result of a beta human chorionic gonadotropin test is negative; urinalysis findings are normal; and levels of sodium, potassium, chloride, carbon dioxide/bicarbonate, BUN, creatinine, and glucose (chem 7) are normal.
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Hint
Reevaluate the history. Is extravasation of the contrast material present?
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Author:
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Mark Thanassi, MD
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Yale University, Yale New Haven Hospital
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eMedicine Editor:
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John Leung, MD
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Northwestern University, Northwestern Memorial Hospital
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eMedicine Case
