Approach to the acute abdomen (pediatrics) Quiz: Ace Your Exams
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An 8-year-old girl presents to the emergency department accompanied by her parent for evaluation of fever and abdominal pain for two days. Her parent states that two days ago, she began complaining of vague abdominal pain. Today the pain worsened and migrated to the lower right quadrant. She also began experiencing fever, chills, nausea, and vomiting. She had three episodes of watery diarrhea and has a decreased appetite. She recently arrived back from a family vacation to Mexico, but the rest of her family remains healthy. Approximately 18 months ago, she had a right ovarian torsion that required surgical management. Temperature is 38°C (101.3°F), heart rate is 90/min, respiratory rate is 20 per minute, blood pressure is 105/70 mmHg, and oxygen saturation is 99% on room air. The patient is uncomfortable and in pain. Abdominal exam is notable for tenderness over the right lower abdomen with rebound and guarding. Which of the following findings on ultrasound would be consistent with the most likely diagnosis?
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