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Special Feature | Oct 2012

Image of the Month—Quiz Case

Neil Lyons, MD; Shams Halat, MD; W. Charles Conway, MD

Arch Surg. 2012;147(10):975. doi:10.1001/archsurg.2011.1494a 10.1001/archsurg.2011.1494b.

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A 32-year-old woman with no recent contraceptive use or significant medical history presented to the general surgery service at our center after experiencing 2 episodes of intra-abdominal hemorrhage. She denied any history of abdominal trauma.

Two weeks before presentation, the patient was seen at an outside hospital reporting severe posterolateral pain on the right side of the neck and mild generalized abdominal pain. Preliminary laboratory evaluation results revealed a hemoglobin level of 8.0 g/dL (to convert to grams per liter, multiply by 10) and an increased human chorionic gonadotropin level of 1500 mIU/mL (conversion to international units per liter is 1:1). The obstetrics department was consulted and diagnosed an ectopic pregnancy of approximately 5 weeks' gestation after transvaginal ultrasonography failed to show intrauterine products of conception. The patient was taken to the operating room for diagnostic laparoscopy, and 600 mL of blood was evacuated from her pelvis; no ectopic pregnancy was visualized. The patient was then discharged home. At follow-up 1 week later, the human chorionic gonadotropin level remained elevated at 1600 mIU/mL prompting treatment with methotrexate sodium.

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Figure 1. An abdominal computed tomographic scan obtained at the referring hospital shows a large hematoma at the superior aspect of the liver (arrow).

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit^TM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 Credit^TM.

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Lyons N, Halat S, Conway W. Image of the Month—Quiz Case. Arch Surg. 2012;147(10):975. doi:10.1001/archsurg.2011.1494a 10.1001/archsurg.2011.1494b.

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