confused doctor
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A 15-lead ECG, two X-rays, an ultrasound, a full-body CT, an MRI with gadolinium, and still, a mystery.

confused doctor
“How is she pregnant?”

“It’s perplexing, that’s for sure,” said Dr. Jouseph Wong, senior obstetrician.  Dr. Wong and his colleagues have been awake for the past 96 hours searching desperately for the cause of an elevated serum β-hCG pregnancy test in their sexually-abstinent patient.

It was 4 days ago when Ally Waterman, 19, presented to the emergency department with a 2-week history of abdominal pain, nausea, and vomiting.  The ED physician documented very clearly that Ms. Waterman denied any sexual activity; however, a nurse in the department had accidentally sent off a β-hCG on the patient before this chart was returned to the nurses station.  What should have returned as a negative result (and a waste of resources), turned into a real-life medical mystery.

Ms. Waterman’s serum β-hCG was elevated; so high that she may have been 4 weeks pregnant.  “But she told me she wasn’t having sex,” said Dr. Imraan Singh, emergency physician.  “I asked her directly, if she was sexually active, she said ‘No,’ then I looked over at her mother (who was standing next to her) and she nodded and confirmed her daughter’s answer.”

With pregnancy ruled out, Dr. Wong and his obstetrics team weren’t sure if they were needed, but he couldn’t resist the puzzle.  “It’s fascinating,” said Wong.  “We’ve been throwing all the imaging we have at her.  We’re just so confounded by this whole case; every now and then I even believe I’m seeing a gestational sac in the uterus.  When that happens I know I’m not thinking clearly and it’s time to take a step back and dive back into the journals.”

The patient, Ms. Waterman, could not be reached for comment, but she plans on following up with the obstetrics team in 9 months.

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