Case of the month- Courtesy of Dr. Muckey

43y G2P2002 F with a history of kidney stones presents with 2 weeks of intermittent LLQ pain acutely worsening over the past 2 days. She describes the pain as starting in her LLQ and wrapping around to her back and oscillating between a 2 and 7 out of 10.  Over the past few hours the pain had become associated with nausea and 3 episodes of emesis. Initially, motrin relieved the pain, but prior to presentation in the ED it was no longer helping. A bedside renal ultrasound revealed the following:

The large cystic structures seen to the left of the bladder prompted the team to obtain a TVUS. The TVUS revealed two left ovarian cysts measuring 3.7×3.5×3 and 4×3.6×3.4cm with normal arterial and venous flow and a small amount of free fluid. Although there was no sonographic evidence of torsion, she was admitted to the gynecology service for observation. During her stay she had worsening of her symptoms prompting the team to take her to the OR for cystectomy. She recovered without complication and was discharged the following day.