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.
Transabdominal view of uterus in longitudinal section.
TA view, uterus transverse with ovaries on either side.
Left iliac fossa, bowel gas.
Right iliac fossa, faeces.
Transvaginal view, uterine fundus longitudinal
TV view, cervix longitudinal
TV view, uterus transverse
TV, left ovary
Right ovary with adnexal mass
Right adnexal mass transverse
Right adnexal mass with flow
Right adnexal mass longitudinal
Right adnexal mass with flow
Answer
- In this case the inflamed appendix lies in the right 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.
- 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
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