CASE 362: ACUTE FEMALE PELVIS PAIN, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Women 21 yo, single, acute  hypogastric pain, polykiuria, normal urine analysis. 

Ultrasound  scanning  in pelvis  shows uterus  normal in size with endometrium thickening, fluid collecting arround  uterus looked like  blood (US 1)  

and  on right  site of uterus exists  one  round mass, size  of 5 cm  with multiple cystic (US 2), 

US 3 =  Color Doppler of  this mass is  normal vascularization, 

US 4 = PW Doppler of  right uterine artery  with RI =0.82.

Sonologist  alerts  bleeding  intrapelvis and  suspected  rupture of right ovary cyst.

MSCT with CE : Non intrauterus pregnancy ( CT1), and this mass  at right parameter  is  cystic in  central part and  thickening wall  with  blood arrounding.  

Radiologist  diagnosis  is  hemoperitoneum due to rupture of luteinic corpus  of  right ovary;  blood collecting volume  arround 100ml.

Blood test  makes sure negative beta HCG.

Clinical finding  is acute pelvis pain in single female  patient, ultrasound  quickly detected  bleeding  intra pelvis  and blood test ruling out a case of ectopic pregnancy.

Ultrasound is  best diagnosis and follow up this case,  no need  CT.

This patient was admitted  OBGY hospital for survey in  3 days and discharged later.

Conclusion:   In female patient,  of acute  pelvis pain case,  ultrasound  is first choice of imaging modalities  for diagnosis about  luteinic corpus   rupture in bleeding, and  beta HCG to  confirm diagnosis of  MITTELSCHMERZT  SYNDROME.