History and Examination

A 32-year-old woman with no significant medical history presents to the emergency department with 2 days of gradually worsening suprapubic and right lower quadrant pain that radiates to the back. The patient has experienced 5 episodes of nonbloody vomiting but denies fever, dysuria, diarrhea, discharge, or other symptoms.

Vital signs are normal. Her abdomen is soft. Diffuse lower abdominal tenderness that is worse on the right side and associated with guarding is noted. Right costovertebral tenderness is identified. The rest of her exam is unremarkable.

Initial concerns include pelvic inflammatory disease, ovarian cyst, pyelonephritis, nephrolithiasis, or appendicitis.

Laboratory assessment reveals a white blood cell count of 11 cells/µL; additional blood test results are normal. Urinalysis identifies small amounts of blood but is otherwise negative. Pelvic ultrasound shows a 3.5-cm simple ovarian cyst on the right side with good flow and no free fluid. Computed tomography (CT) scan of the abdomen and pelvis is obtained (Figure 1).

What are the findings on diagnostic imaging?

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