Case 337

Medical history

Pregnant woman, 32 years old, 10 weeks of gestation, G5P3A1, at the Emergency Service due to sudden and intense abdominal pain, without other complaints or comorbidities. At the exam: regular general condition, tachycardic, eupneic, afebrile, feeling pain at deep palpation in the left iliac region, with painful decompression. Pelvic examination: pain at palpation of the left annex. Previous obstetric ultrasonography (US): normal gestation of 8 weeks and presence of fetal heartbeats. Pelvic US performed (presented images).

Considering the images and the clinical history described, what is the most likely diagnosis?

Test Question

UFRJ (2009) - Lígia, 22 years old, at the emergency care unit of Maré presenting sudden and increasing pelvic pain and fever of 37,5°C. Last menstruation 25 days ago and sexual inactivity since 2 months ago. Recent abdominal ultrasonography shows adnexal tumor of 12 cm of diameter, cystic and low perfusion at the Doppler velocimetry. 

The most likely diagnosis is:

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