405.A 17-year-old girl presents to the ED with vaginal bleeding, nausea, and
vomiting. Her vitals include HR of 80 beats per minute, BP of 190/100 mm Hg,
and temperature of 99°F. She reports her last menstrual period was 7 weeks
ago. Her physical examination is significant for a fundal height at the
umbilicus. After obtaining a positive β-hCG, sonographic evaluation reveals
the following image shown below. What is the most likely underlying con-
dition for this patient’s symptoms?
442 Emergency Medicine
a. Ectopic pregnancy
b. Hydatidiform mole
c. Ovarian torsion
d. Abruptio placentae
e. Hyperemesis gravidarum
(Reproduced, with permission, from Knoop KJ, Stack LB, Storrow AB. Atlas of Emergency
Medicine. New York, NY: McGraw-Hill, 2002: 272.) (Courtesy of Robin Marshall, MD.)