Diagnosis of appendicitis by transvaginal ultrasound examination

Abstract

Background: Appendicitis is a frequent cause of abdominal pain. Symptoms may be atypical, and the appendix may not be visualised through abdominal ultrasonography. This case report illustrates the important role transvaginal ultrasound examination may have in the diagnostic workup of abdominal pain. Methods: A case report focussing on imaging through transvaginal ultrasonography and comparing the ultrasonographic findings with CT-scan, as well as macroscopic examination and microscopy. Results: A 33-year-old woman presenting at the emergency department with lower abdominal pain since 1 week. Transvaginal ultrasound shows a typical ‘target sign’ together with a blind-ending fluid-filled structure posterolateral right of the uterus, suggestive of appendicitis. These findings are confirmed on CT-scan, and a laparoscopic appendectomy is performed. We present the typical ultrasound imaging alongside the correlates on CT-scan as well as on macroscopy and on microscopic examination. Conclusion: As gynaecologists, we must maintain a high degree of suspicion for non-gynaecological findings. This case report illustrates the value of transvaginal ultrasound in diagnosing appendicitis.