Case Presentation: A 33-year-old nulliparous female with no past medical history presented with 10 months of postmenstrual umbilical pain. She denied vomiting or bowel habit changes, but noted recent orthopnea and nocturnal wheezing. She had regular, monthly menstrual cycles associated with dysmenorrhea since menarche at age 11.  She had not been sexually active for 4 [...]