A 25-Year-Old Woman With Diffuse Abdominal Pain and Shock

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A 25-Year-Old Woman With Diffuse Abdominal Pain and Shock Amen Sergew, MD, Amy L. Olson, MD, Marvin I. Schwarz, MD, FCCP CHEST Volume 136, Issue 5, Pages 1435-1440 (November 2009) DOI: 10.1378/chest.08-2884 Copyright © 2009 The American College of Chest Physicians Terms and Conditions

Figure 1 Abdominal/pelvic CT scan shows multiple loops of bowel with peritoneal enhancement (black arrow), bowel wall thickening (white arrow), and a large amount of ascites. There was also bilateral hydrosalpinx/pyosalpinx, which was greater on the left than the right (dashed arrow). CHEST 2009 136, 1435-1440DOI: (10.1378/chest.08-2884) Copyright © 2009 The American College of Chest Physicians Terms and Conditions

Figure 2 Abdominal ultrasound showing multiple areas of thick irregular septations in the ascitic fluid suggestive of loculation. The color Doppler ultrasound shows hyperemia in the areas of inflamed tissue. The ascitic fluid is minimally echoic with mild internal echoes, which is more suggestive of simple fluid than thick pus. CHEST 2009 136, 1435-1440DOI: (10.1378/chest.08-2884) Copyright © 2009 The American College of Chest Physicians Terms and Conditions

Figure 3 Peritoneal tissue showing two well-formed nonnecrotizing granulomas. The black arrow indicates a giant cell (hematoxylin-eosin, original ×10). CHEST 2009 136, 1435-1440DOI: (10.1378/chest.08-2884) Copyright © 2009 The American College of Chest Physicians Terms and Conditions