Welcome to this Contemporary Pediatrics poll. Take a look at the following case below. After reading through the description, choose a multiple-choice answer and try to guess the correct patient diagnosis.

Then visit our website on Wednesday, November 12, 2025, at 12:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

This case was presented by Abigail A. Childress, BS, Allison M. Davis, MD, and Lissa X. Yu, MD.

THE CASE:

This 18-year-old female was diagnosed in early childhood with Goldenhar syndrome (oculo-auriculo-vertebral syndrome). She has a history of congenital D-transposition of the great vessels status post repair, right ventricle pulmonary artery conduit, cardiac ablation for arrhythmia, developmental delay, and melody valve. At age 16, she had a pelvic ultrasound suggestive of an ovarian cyst, and she was advised on expectant management. At age 18, she initially presented with severe abdominal pain and vomiting prompting a visit to urgent care from which she was discharged.

Four weeks later, the patient presented to a local emergency department with recurrence of severe nausea, vomiting, and abdominal pain. Initial vital signs in the emergency department showed temperature 36.2°C, pulse 94 bpm, respirations 18, SpO2 99%, and blood pressure 186/110. The urine sample showed no obvious infection. White blood cell count (WBC) was elevated at 14.35. A CT scan was performed, which showed the following findings:

1. Mullerian duct anomaly with a right hemiuterus and a rudimentary left cavity. There is fluid distention of the left rudimentary cavity measuring up to 3.2 cm.
2. Tubular cystic structure in the left adnexa compatible with hydrosalpinx. Consider further evaluation with pelvic ultrasound.
3. Multiple metallic densities in a linear distribution within segments 4A and 4B in the left hepatic lobe anteriorly with adjacent periportal hypoattenuation, presumably secondary to prior intervention such as prior embolization.
4. Partially imaged cardiomegaly.

The patient was discharged after symptoms improved with antiemetics and pain medications.

The following day, the patient presented to a different emergency room with temperature 36.7°C, heart rate 97, SpO2 96%, respirations 24, and blood pressure 166/98. WBC had increased to 16.3. C-reactive protein was 1.0. Basic metabolic panel, and procalcitonin were within normal limits. At this time, due to abnormalities on EKG, she was admitted to the cardiology service overnight for monitoring in the setting of her surgically repaired congenital cardiac anomaly. She was discharged the following day.

Below, take your best guess at diagnosing this patient.

Be sure to visit our website on Wednesday, November 12, 2025, at 12:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

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