Case 338

A 25-year-old female patient presented to the emergency department with worsening abdominal discomfort over the past 2-3 months. The patient had not experienced fever, chills, or dysuria. Past medical history was notable for two completed pregnancies; otherwise, there was no pertinent medical history or family history. At physical examination, the patient was uncomfortable but not in acute distress. There was tenderness to palpation in the right upper quadrant and epigastric region, but no rebound tenderness or guarding. Vital signs were blood pressure of 141/85 mm Hg, pulse rate of 91/min, and temperature of 37.2 °C. The serum β-human chorionic gonadotropin test result was negative for pregnancy, and urinalysis showed no leukocyte esterase or nitrites. Routine blood investigations, including white blood cell count, were within normal limits. Initial evaluation with contrast-enhanced CT of the abdomen and pelvis was performed (Fig 1), followed by MRI of the abdomen without and with intravenous contrast material (Fig 2).