Double Trouble
Female Reproductive System & Breast
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/G1_F1.jpg"}},{"insert":"\n\n"},{"insert":"An unbroken line of cars stretches ahead of you.\n\nYou impatiently drum your fingers on the steering wheel, as you inch your way forward through the early morning traffic.\n\nYour phone suddenly rings. You switch it onto \u0022hands free\u0022 mode, and answer the call.\n\n\u0022Good morning, Doctor! This is Julie Smith.\u0022\n\nYou remember Julie, from your fertility clinic. She underwent in-vitro fertilization (IVF) just a few weeks ago.\n\nJulie complains of mild abdominal pain for the last 3 days, which has worsened over time.\n\nYou tell her that you are on your way to the hospital, and ask her to meet you there.\n"}]}
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{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/G1_F2.jpg"}},{"insert":"\n\n"},{"insert":"When you arrive at your office, you see a worried looking Julie, who is being consoled by her friend Anne.\n\nPerusal of her records reminds you that 30-year-old Julie underwent In Vitro Fertilisation (IVF) and Embryo Transfer (ET) recently, and that she is now at 6 weeks + 5 days of gestation.\n\nShe underwent controlled ovarian stimulation, where 38 oocytes were collected. During IVF, her peak serum estradiol level was 4.805 pg\/mL.\n"}]}
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{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/G1_F3.jpg"}},{"insert":"\n\n"},{"insert":"You examine Julie. Her vital signs are stable.\n\nHer abdomen is mildly distended, without any tenderness. However, pelvic examination reveals mild tenderness in the left adnexum.\n\nThe remainder of the examination is unremarkable.\n\nYou perform a pelvic ultrasound, and notice a single intrauterine gestational sac of 0.7 cm.\n\nBoth the left and right ovaries are enlarged, being 5.2 cm and 4.4 cm respectively, with multiple complex follicles.\n\nA 10 x 9 x 9 cm hemorrhagic mass with mixed echogenicity is seen in proximity to the the enlarged left ovary. Minimal free fluid is also present.\n\nThere are no features suggestive of a cornual pregnancy.\n\nHer basic hematological and biochemical investigations are all within normal parameters.\n\nAs you complete the scan, Julie mentions that the pain commenced soon after a workout 3 days ago.\n\nShe did not think too much about it at that time, but is now worried that it might be connected to her symptoms.\n"}]}
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{"ops":[{"insert":"What do you do now?\n"}]}
1. Keep Julie under observation for several hours
2. Opt for immediate surgery
3. Order an MRI of the Pelvis
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