MDM - Ovarian Cyst

[##]-year-old female with [right/left lower quadrant abdominal/pelvic pain] with history and exam consistent with [right/left hemorrhagic] ovarian cyst.

Initial consideration in this patient included ovarian cyst (functional, follicular, and hemorrhagic), ovarian mass, polycystic ovarian syndrome (PCOS), ovarian neoplasm, pregnancy, ectopic pregnancy, appendicitis, diverticulitis, other intra-abdominal etiologies, urinary tract infection (UTI), ureteral stone and pyelonephritis, and vaginitis among others.

Patient presented with [right-sided/left-sided] abdominal and pelvic pain [with/without] a history of prior ovarian cyst.  Patient was noted to have [no] evidence of peritonitis on exam in the ED [prompting early discussion with gynecology due to concern for ovarian torsion/bedside FAST exam due to concern for ruptured ectopic].  A pelvic [speculum/bimanual] exam was performed and notable for [right-sided/left-sided tenderness/mass/cervical motion tenderness (CMT)].  A pregnancy test was obtained and noted to be negative making pregnancy-related complications unlikely.  A pelvic ultrasound was obtained and [notable for ## cm follicular/hemorrhagic right-sided/left-sided ovarian cyst/free fluid and findings consistent with ruptured ovarian cyst without evidence of ovarian torsion].  Patient felt to be at [low/moderate] risk for ovarian torsion based on ovarian cyst size [less than 2 cm (very low risk)/less than 4 cm (lower risk)/greater than 4 cm (higher risk)/greater than 6 cm (high risk consider discussion with gynecology)] with discussion [of specific return precautions/with Dr. Name of Gynecology with recommendations].  Ovarian neoplasm felt to be [unlikely/less likely/possible] in patient who is [still having regular menses/postmenopausal] with discussion of appropriate follow up.

Patient noted to have no evidence of significant anemia on [exam/hemoglobin and hematocrit].  Patient noted to have no evidence of coagulopathy on [history/exam/labs].  No evidence of UTI on urinalysis in the ED.  Vaginitis considered unlikely based on history and exam.  Patient noted to have improvement in pain with [NSAIDs/etc.] in the ED prior to discharge.

Prior to discharge, we discussed return precautions, specifically for evidence of anemia from significant bleeding and ovarian torsion, symptomatic treatment [with specify interventions], and follow up with [primary care doctor/Gynecology] within [2-3 days/1 week] for further evaluation, and the patient demonstrated understanding and agreement with this plan.

https://www.aafp.org/afp/2016/0415/p676.html