Introduction:
Acute, unilateral abdominal pain with nausea comes with a large differential in women. While kidney stones are one of the most common reasons for an emergency department visit with these symptoms, it is vital that healthcare providers do not allow themselves to become anchored to such an initial diagnosis. Further evaluation to consolidate that diagnosis in an emergency department setting may entail ultrasound, which has sensitivity for other possible causes of abdominal pain, and consulting OB/GYNs on call.

Case Presentation:
We present the case of a 38-year-old female who presented with worsening abdominal pain and nausea after recent treatment for nephrolithiasis. Imaging and further evaluation of her symptoms suggested the cause was a complex adnexal mass that had been noted when she was diagnosed with kidney stones via non-contrast CT. She had been discharged without further evaluation of the mass at her previous visit and recommended to follow up with OB/GYN. CT imaging obtained at this visit suggested the adnexal mass had ruptured.

Final Diagnosis:
The mass was determined to be a multiloculated cyst that served as a nidus for ovarian torsion.

Outcome:
Through surgical intervention, the patient was restored to baseline. Pathology determined that the cystic mass was benign. This case highlights the importance of establishing a broad differential and exploring all findings. Ovarian masses are prevalent and carry risk for malignancy, rupture, and torsion. The use of ultrasound to further evaluate masses in the ED setting may produce better patient outcomes, reducing the time burden on healthcare workers and the financial burden on patients. Additionally, we acknowledge the need to approach patients with a wide differential, including OB/GYN conditions in what seems to be a clearcut medicine case.

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