Appendicitis Diagnosed by Emergency Physician Performed Point-of-Care Transvaginal Ultrasound: Case Series
The third case was an 18-year-old female with lower abdominal and pelvic pain for 1 week starting during her menstruation. She was afebrile with normal vital signs. Examination elicited right lower quadrant tenderness with guarding and no masses. Gynecologic examination demonstrated right adnexal tenderness without cervical motion tenderness, masses, lesions or discharge. Laboratory analysis was only pertinent for a leukocytosis of 12.1 K/uL.\nA point-of-care endovaginal US was performed to evaluate for gynecologic pathology. A large amount of free fluid was present. Upon scanning the right adnexa an irregular tubular structure, containing an appendicolith, with surrounding hyperemia was seen (). There was exquisite tenderness over this non-compressible structure, which measured 2.02 cm. The appendix was not visualized with transabdominal imaging. The patient was admitted to the surgical service and the diagnosis of perforated appendicitis was confirmed.