Appendicitis Diagnosed by Emergency Physician Performed Point-of-Care Transvaginal Ultrasound: Case Series
The second patient was a 20-year-old female complaining of right lower quadrant and suprapubic abdominal pain and nausea for 1 day. The patient denied fever, vomiting, diarrhea, vaginal bleeding or vaginal discharge. Past medical history was significant for renal colic 1 year prior. Vital signs were again within normal limits without fever. The physical examination demonstrated a soft abdomen with right lower quadrant tenderness and rebound. No cervical motion or adnexal tenderness, masses, or discharge were noted on gynecologic examination. Laboratory evaluation was remarkable only for a leukocytosis of 18.2 K/uL. Urine pregnancy testing, complete metabolic panel and urinalysis were negative.\nTransabdominal US was performed without visualization of the appendix. Transvaginal US was then performed by the EP, revealing a 3.8 cm right ovarian complex cystic structure. Bilateral ovarian stroma demonstrated normal echotexture with no signs of torsion. In the right adnexa, a 7 mm blind- ended, non-peristalsing, non-compressible, tubular structure with wall edema and surrounding free fluid was identified consistent with acute appendicitis (). The patient was admitted to the surgical service for appendectomy. Laparoscopic resection was performed and pathology confirmed the diagnosis.