Differential Diagnosis for Pelvic Pain in a 27-year-old Woman
- Single most likely diagnosis
- Ectopic pregnancy: The combination of pelvic pain, amenorrhea, and a tender adnexal mass is highly suggestive of an ectopic pregnancy, which occurs when a fertilized egg implants outside the uterus, often in the fallopian tube.
- Other Likely diagnoses
- Ovarian cyst or torsion: A tender adnexal mass could also represent an ovarian cyst that has ruptured or become twisted, cutting off its blood supply.
- Pelvic inflammatory disease (PID): PID, often caused by sexually transmitted infections, can lead to pelvic pain, adnexal tenderness, and sometimes a palpable mass if an abscess has formed.
- Endometriosis: While less likely to cause a distinct adnexal mass, endometriosis can lead to pelvic pain, especially if there are endometriomas (cysts filled with old blood) on the ovaries.
- Do Not Miss
- Ruptured ectopic pregnancy: This is a medical emergency that requires immediate surgical intervention. The symptoms can initially be similar to those of a non-ruptured ectopic pregnancy but can quickly escalate to severe abdominal pain, shock, and even death if not promptly treated.
- Ovarian torsion: This condition, where the ovary twists around its ligaments, cutting off blood supply, is an emergency that requires immediate surgical intervention to save the ovary and prevent further complications.
- Appendicitis: Although the pain is typically more right-sided, appendicitis can sometimes present with pelvic pain and must be considered, especially if the pain is severe and accompanied by fever and vomiting.
- Rare diagnoses
- Malignant ovarian tumor: While rare in young women, ovarian cancer can present with pelvic pain and a palpable mass.
- Tubo-ovarian abscess: A complication of PID where the infection collects in the fallopian tube and ovary, forming an abscess, which is a rare but serious condition requiring prompt antibiotic treatment and possibly drainage.