Visual Journal of Emergency Medicine 6 (2017) 62
Contents lists available at ScienceDirect
Visual Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/visj
Visual Case Discussion
A rising beta-HCG in a young female with abdominal pain ⁎
MARK
Rohit B. Sangal, MD , Jayaram Chelluri, MD, MHSA Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
A R T I C L E I N F O Keywords: Molar pregnancy Ultrasound Gestational trophoblastic disease Complete hydatidiform mole
A 24 year old G3P1011 presents to the ED with abdominal pain. She presented to an ED one month ago where she was told she was pregnant and “miscarrying.” An intrauterine pregnancy was reportedly
visualized but no fetal heart rate noted. She was told her B-HCG quantitative was 47,000. Since then she continues to have intermittent spotting without passage of tissue or clots. She presents for worsening bilateral lower abdominal pain, foul discharge, nausea and vomiting. She is tender in both lower quadrants and uterus measures 10–12 weeks in size. Pelvic exam is notable for no cervical motion tenderness, old blood at the cervical OS which is dilated to fingertip. An emergency medicine bedside ultrasound confirmed the diagnosis (Fig. 1, Video 1). B-HCG quantitative today is 97,000. Appendix A. Supplementary material Supplementary data associated with this article can be found in the online version at http://dx.doi.org/10.1016/j.visj.2016.09.014. References
Fig. 1. Trans-abdominal still image of the uterus with curvilinear probe showing hypervascularity of the uterus.
1 Acute Complications of Pregnancy, Houry DE, Salhi BA . Rosen’s Emergency Medicine 2014; 2014, pp.2282–2299. 2 Current Management of Gestational Trophoblastic Disease , Berkowitz RS, Goldstein DP. Gynecol Oncol. 2009;112(3):654–662. 3 Lurain John R. Gestational trophoblastic disease I: epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease and management of hydatidiform mole. Am J Obstetr Gynecol. 2010;203(6):531–539.
⁎ Corresponding author: Rohit B. Sangal, MD: Hospital of the University of Pennsylvania, Department of Emergency Medicine, 3400 Spruce Street, Philadelphia, PA 19104. email:
[email protected].
http://dx.doi.org/10.1016/j.visj.2016.09.014 Received 8 September 2016; Accepted 17 September 2016 2405-4690/ © 2016 Elsevier Inc. All rights reserved.