Rosh Emergency Medicine Practice Test

What ultrasound finding is most likely in a patient with acute severe pelvic pain and a palpable adnexal mass?

1. Enlarged ovary

2. Free pelvic fluid

3. Normal sized ovary with multiple small follicles peripherally

4. Simple ovarian cyst with a diameter of 3 cm

The correct answer is: Enlarged ovary

In the context of a patient presenting with acute severe pelvic pain and a palpable adnexal mass, the finding of an enlarged ovary is significant as it suggests associated pathology, possibly related to conditions such as ovarian torsion or an ovarian cyst. An enlarged ovary can indicate that the ovary is engorged with blood or fluid, which can occur in the setting of torsion where the blood supply is compromised, or in other scenarios where ovarian pathology is present. The palpable adnexal mass can correspond directly with the enlarged ovary, leading to the acute pain the patient experiences. While other findings, such as free pelvic fluid, normal-sized ovaries with multiple small follicles, or simple ovarian cysts may also appear on an ultrasound, they do not directly correlate with the acute presentation of severe pain and a palpable mass in the same way that an enlarged ovary does. In particular, free pelvic fluid may indicate other underlying issues such as ruptured ectopic pregnancy or hemorrhagic cysts but does not fully explain the palpable adnexal mass often linked to an enlarged ovary.