Approach to adnexal masses Quiz: Ace Your Exams
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A 25-year-old non-binary person, assigned female at birth, gravida 0, presents to the emergency department with 2 hours of sudden-onset, severe left lower quadrant pain unrelieved by ibuprofen. The symptoms are associated with nausea, but without vomiting. Review of systems is otherwise negative. Past medical history is notable for prior use of intramuscular testosterone injections for twelve months at age 20. The patient takes no oral medications but has a levonorgestrel-releasing intrauterine device (IUD) in place for contraception and menstrual suppression. Temperature is 36.5 °C (97.7 °F), pulse is 94/min, respirations are 18/min, and blood pressure is 122/80 mmHg. On exam, the patient has exquisite tenderness in the left lower quadrant, with rebound tenderness and guarding. A bimanual exam reveals a tender, enlarged left adnexa. Urine pregnancy test is negative. Pelvic ultrasound shows an 8 cm complex left adnexal mass with heterogeneous contents, an echogenic nodule with posterior shadowing, fat fluid levels, and absent blood flow to the adnexa on Doppler exam. Which of the following is the most appropriate next step in management?
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