Right lower quadrant pain. Concern for appendicitis. PER EPIC NOTE: On transabdominal vaginal exam, +IUP visualized, Patient was tender in RLQ, images suggesting appendicitis. Will contact Gynecology, MRI, labs added. ABDOMEN:LIVER, BILIARY TRACT: Mild loss of signal on out of phase imaging compatible with diffuse hepatic steatosis. The liver is otherwise normal in morphology and size without a focal abnormality.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The endometrial cavity is distended with heterogeneous signal intensity material near the fundus compatible with proteinaceous/blood product. In the lower uterine segment/cervical canal there is a well-defined bi-lobed cystic structure which may correspond to the patient's reported IUP/gestational sac. 2.0 x 1.2 cm submucosal/intramural left fundal fibroid. Focal anterior junctional zone/inner myometrial thickening up to 1.7 cm may be related to gravid state. The adnexa are unremarkable. There is trace free fluid in the pelvic cul-de-sac. There are prominent periuterine vessels which is nonspecific and may be related to gravid state.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is not definitely seen by MR.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.The appendix is not definitively identified by MR.2.Dilated endometrial cavity containing heterogeneous proteinaceous/blood product and a cystic bi-lobed structure in the lower uterine segment/cervical canal which may correspond to the patient's reported IUP/gestational sac, correlate with pelvic ultrasound.