HPI: 15 y/o female who presented to the ED with history of brief episodes of palpitations daily for one month. Symptoms commonly occur while showering or shortly after showering and not associated with strenuous activity. Patient denies syncope, shortness of breath and cyanosis, chest pain, exercise intolerance, weight loss or recent dental surgery. Of note, patient has been having dysfunctional uterine bleeding for 1 month requiring the use of feminine hygiene products daily.
Fam Hx: Mom with mitral valve prolapse, Sister with Ehlers-Danlos Type II.
SHx: No smoking, drug use, ETOH use
Meds: Occasional NSAIDS
PE: T 37.7, P 83, RR 19, BP 118/75, 100%RA
General: Alert and oriented x 3
Heart: S1/S2, no murmurs, gallops or rubs, good distal pulses
Lungs: Clear
Abd: Soft, non-tender no hepatosplenomegaly
Ext: Warm and well perfused, no signs of clubbing or cyanosis
Her bedside ultrasound leads to the diagnosis:
A: Thrombus
B: Infected thrombus
C: Myxoma
D: Sarcoma
Case of the Month (January 1, 2012 - February 15, 2012) by Dr. Catherine Chung
HPI: 12y/o female presents with lower pelvic pain for the past 2 months. She also complains of urinary retention and constipation. She otherwise denies
any weight loss, vomiting, fevers. She denies any sexual activity and has not begun menstruation.
PE: VSS, awake, no pain
Chest: tanner stage 3
CVS: S1/S2, RRR
Lungs: Clear
Abd: Lower abdominal fullness with diffuse mild tenderness in lower quadrants, no rebound
The answer is C.
Imperforate hymen is a rare condition that is reported to occur in 0.1% of infant females but is the most common cause of vaginal outflow obstruction. (1)It is thought to be due to a failure of apoptosis of the hymen, which normally perforates during embryological development. (2) It is often diagnosed during puberty due to the retention of menstrual blood inside the uterus which is called hematometrocolpos.Patients usually present with amenorrhea, lower abdominal pain with or without urinary symptoms and constipation due to the mechanical obstruction from the enlarged uterus.(3)
Diagnosis is made by physical examination of the vaginal area which reveals the imperforate hymen which appears as a bulging pink or blue membrane.Ultrasound is a quick and noninvasive way to diagnose hematocolpos, hematometrocolpos and urinary tract anomalies.Ultrasound images will reveal an enlarged uterus w/ homogenous intrauterine and intravaginal fluid.Treatment is surgical incision of the hymen and has good outcomes.
References:
1. Stelling JR, Gray MR, Davis Aj, et al: Dominant transmission of imperforate hymen. Fertil Steril 2000; 74:1241.
3. Fleisher G, Ludwig S. (2010). Congenital Vaginal Obstruction. Lippincott Williams and Wilkins, Textbook of Pediatric Emergency Medicine (pg 841-843).
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Presentations for this Section: Friday, October 19, 2012. Oral Presentations will take place 1:00 - 5:30pm. Poster will be displayed during the reception from 5:30 - 7:00pm.
The Section on Emergency Medicine accepts abstracts related to any aspect of pediatric emergency medicine.
Abstracts will be accepted for podium (oral) presentations as well as poster presentations. Abstracts submitted may be considered for either format at the discretion of the Abstract Review Committee.
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HPI: 12y/o female presents with lower pelvic pain for the past 2 months. She also complains of urinary retention and constipation. She otherwise denies
