A 28 year old lady who is 26 weeks pregnant presents with severe right sided abdominal pain for 1 day associated with nausea and vomiting. This is her first pregnancy. Her medical and gynecological histories are unremarkable.
WBC/DC: 13,400/mm3 N: 75% L: 20% Hb: 12.9 g/dl Hct (PCV): 38% Platelets: 336,000/mm3
Pus cells: 1 - 2 /hpf RBC: nil/hpf pH: 5.5 Nitrite dipstick test: negative
The cardiotocogram shows a fetal heart rate within normal parameters. There is no evidence of uterine contractions.
A 6cm x 6cm echogenic mass is noted in the anterior wall of the uterus, corresponding to the area of abdominal tenderness. No urinary calculi are noted, while the appendix is not visualized. Both ovaries appear normal, with satisfactory blood flow.