Ultrasound Killed the Pelvic Examination: Over-reliance on Ultrasound Resulted in Delayed Diagnosis of Fitz-Hugh–Curtis Syndrome and Potential Loss of Fertility in a Young Female Patient

We describe a case of multiple missed opportunities to diagnose Fitz-Hugh–Curtis syndrome in a sexually active 26-year-old woman in the emergency department (ED). Repeat ultrasound scans showed a hemorrhagic ovarian cyst. Multiple ED providers relied exclusively on these ultrasound findings as the presumed cause of her pelvic pain, to the detriment of their physical examination. A manual pelvic examination was not performed until her fourth ED return visit, which showed mucopurulent discharge. On the basis of our findings, obstetrics and gynecology team was consulted and the patient underwent diagnostic laparoscopy, which revealed extensive adhesions suggestive of pelvic inflammatory disease (PID) and Fitz-Hugh–Curtis syndrome. With the advent of ultrasound, we have noticed providers rely on technology to the detriment of their physical examination skills. Many ED providers are hesitant to perform a pelvic examination when a transvaginal ultrasound has already suggested a cause of the patient's pain. Ultrasound will not and cannot diagnose PID.