27 y.o female presents to ob-gyn office with complaints of a | Figure 1

27 y.o female presents to ob-gyn office with complaints of abdominal discomfort and possible pregnancy. Patient aware of growing abdomen for months and assumed it was a pregnancy. She was unsure of when to report to OB office. Physical exam revealed a fluid wave and an abdomen approximately the size of a 30 week pregnancy. Initial lab tests revealed a positive pregnancy test; however, quantitative hcg was inappropriate for he size of the abdomen. U/S was done initially due to positive pregnancy test and to evaluate for ascitis. Drainage of fluid revealed a fluid filled mass not ascitis. Ddx?

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CT scans are often requested for vague abdominal pains- often with negative findings. Female pelvis scans are often “busy” and minor, often insignificant findings are easily overlooked in a busy department. Case 1: 30 yr female with LIF pain for a few days. Arrows show normal anatomy: Blue= bladder filled with urine, Yellow= uterus enhanced by IV contrast, Green= free fluid in front of rectum, in Pouch of Douglas ( most likely from ruptured left ovarian follicle), Red= normal right ovary ( to compare with left ovary), Purple = Corpus Luteum in left ovary, formed after follicle ruptured. Note the enhancing ring of the CL, typically seen on vascular US as a “ring of fire”. Case 2: 50 yr female with vague LIF pain. Purple arrow=Mature Cystic Teratoma in left ovary. Note the low density similar to the fat in the subcutaneous tissues - Yellow arrows. Blue arrow in coronal image show a dermoid plug, inferiority, within the fat like contents. ( These are not dramatic cases, but can be easily overlooked)


22 y/o female presented with acute onset of abdominal pain with passage of large clot/blood per #vagina 3 days prior to ED arrival. U/S showed possible #ectopic with fluid/blood in #Abdomen / #Pelvis . Urgent exploratory #Laparoscopy revealed #Uterus (green) floating in ~600 cc blood in pelvis/lower #Abdomen and #Ectopic-pregnancy of the left #Fallopian-tube (yellow). #Ovary(ies) (white both ok)


26-year-old female presenting with right lower quadrant pain and positive home pregnancy test. Absent intrauterine gestation.
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Adult female in the ED, positive pregnancy test and lower abdominal pain.]


A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.
He had a history of hypertension, long-term smoking, and a sedentary lifestyle.
On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.


A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets.
Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.


A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.


patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?