PID masquerade

History

This young woman presented with pelvic pain of 24 hours duration. On examination she had pelvic excitation and PID was considered the most likely diagnosis clinically.

Below are the still images transbdominally and transvaginally. Look at the answer which includes a clip and full description of the ultrasound findings.

https://gmep.org/media/11572

Transabdominal view of uterus in longitudinal section.

https://gmep.org/media/11573

TA view, uterus transverse with ovaries on either side.

https://gmep.org/media/11574

Left iliac fossa, bowel gas.

https://gmep.org/media/11575

Right iliac fossa, faeces.

https://gmep.org/media/11576

Transvaginal view, uterine fundus longitudinal

https://gmep.org/media/11577

TV view, cervix longitudinal

https://gmep.org/media/11578

TV view, uterus transverse

https://gmep.org/media/11580

TV, left ovary

https://gmep.org/media/11579

Right ovary with adnexal mass

https://gmep.org/media/11581

Right adnexal mass transverse

https://gmep.org/media/11582

Right adnexal mass with flow

https://gmep.org/media/11583

Right adnexal mass longitudinal

https://gmep.org/media/11585

Right adnexal mass with flow

Answer

[DDET Ultrasound findings]

https://gmep.org/media/11586

  • In this case the inflamed online casino appendix lies in the right National Lab physicist Michael Smith, for high fashion design schools students on how physics, technology and math are used to solve the mysteries on the night sky. adnexa between the right ovary and uterus. It is not surprising there was cervical excitation.
  • BHCG was negative for those of you concerned this adnexal mass was an ectopic.

[/DDET]

[DDET Take home messages]

  • Appendicitis is sometimes found on transvaginal ultrasound when transbdominal scanning has been unsuccessful.
  • This case demonstrates the classic features of acute appendicitis listed below, but also shows incongruity of the appendiceal wall and a small walled off periappendiceal abscess.
  • In acute appendicitis the appendix typically develops the following characteristics:
    • Distended to more than 6mm in diameter
    • Non compressible
    • Tender to probe palpation
    • Echogenic mesentry surrounding it
    • Small amount of free fluid
    • Hyperaemia
    • An appendicolith may be present
    • Complications such as perforation and abscess formation may be present

[/DDET]

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