History of Present Illness

A 32-year-old woman presents to the emergency department (ED) with a history of left hip pain for 1 week. According to the ED examination, the patient has left groin pain with bilateral lower quadrant pain and intermittent anal cramping. She has no history of fever, diarrhea, constipation, or vomiting. The patient reports no vaginal discharge, dysuria, new sexual partners, or anal receptive intercourse and has no other complaints.

Vital Signs and Physical Examination

The patient’s vital signs are normal; however, her pulse rate is 95 beats/min, which seems high. Her physical examination is normal except for diffuse mild lower abdominal tenderness without guarding or rebound. There is no aggravation of pain with hip rotation or straight leg raise and distal pulses are symmetric.

A full diagnostic laboratory report is pending. A bedside point of care ultrasound (US) is performed (Figure).

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