An adolescent athlete with chronic back pain
A 15-year-old female presented to the emergency department with severe pelvic and back pain, on the background of chronic pelvic pain. She reported that she had been experiencing pain for approximately two years, but that her pain had become increasingly disabling over the past six weeks. Her pain was located in both lower quadrants, with radiation to her back. She denied any fevers, chills, urinary symptoms or changes in her bowel movements. The patient had never experienced menses or any vaginal bleeding. She denied sexually activity, had never had a Pap smear, nor any sexually transmitted infections. She was a competitive figure skater but had been unable to continue in this activity because of the pain. She had been followed by sports medicine and despite physiotherapy had not improved. She was otherwise healthy, with no significant past medical conditions.
On examination, she was afebrile and her vital signs were all within normal limits. On abdominal examination, she had supra-pubic tenderness and a mass was palpated at the level of her umbilicus.
Bloodwork, including a blood count, was normal and a plain film of the lumbar spine was unremarkable. Point-of-care ultrasound (POCUS) led to the diagnosis.....
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