Differential Diagnosis for the 21-year-old woman with severe right lower quadrant pain
- Single most likely diagnosis
- Ovarian Torsion: The patient's symptoms of severe right lower quadrant pain, nausea, vomiting, and the presence of a tender, right adnexal mass with decreased Doppler flow to the right ovary on ultrasound are highly suggestive of ovarian torsion. The partially calcified, right ovarian mass with multiple thin, echogenic bands may indicate an underlying ovarian cyst or tumor that has undergone torsion.
- Other Likely diagnoses
- Ectopic Pregnancy: Although the pregnancy test is negative, it's essential to consider ectopic pregnancy, especially given the patient's symptoms and the presence of an adnexal mass. However, the negative pregnancy test and the ultrasound findings make this less likely.
- Ovarian Cyst: The patient's ultrasound shows a 6-cm, partially calcified, right ovarian mass, which could be a simple or complex ovarian cyst. However, the presence of decreased Doppler flow and the patient's severe symptoms suggest a more complicated condition like torsion.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Appendicitis: Although the patient's symptoms and ultrasound findings suggest an ovarian pathology, appendicitis can present with similar symptoms and must be considered, especially given the risk of perforation and peritonitis.
- Ruptured Ectopic Pregnancy: As mentioned earlier, although the pregnancy test is negative, a ruptured ectopic pregnancy can be life-threatening and must be ruled out, especially if the patient's condition worsens or if there's any suspicion of internal bleeding.
- Rare diagnoses
- Malignant Ovarian Tumor: Although rare in young women, malignant ovarian tumors can occur and may present with similar symptoms and ultrasound findings.
- Dermoid Cyst with Torsion: A dermoid cyst is a type of ovarian tumor that can undergo torsion, presenting with severe pain and decreased Doppler flow on ultrasound. However, this is less likely given the patient's age and the ultrasound findings.