Appendicitis Diagnosed by Emergency Physician Performed Point-of-Care Transvaginal Ultrasound: Case Series
The first case involved a 20-year-old female who presented with 2 hours of sudden onset right-sided abdominal pain radiating to her groin. She had been undergoing treatment for a urinary tract infection with trimethoprim/ sulfmethaxazole. The patient exhibited no nausea, vomiting, diarrhea, vaginal discharge or vaginal bleeding. Vital signs were within normal limits without fever. The abdominal examination revealed focal right lower quadrant abdominal tenderness without rebound, guarding or masses. Adnexal tenderness on the right was also noted, and there were no genital lesions, masses, vaginal discharge or cervical motion tenderness. The urine pregnancy test was negative. Laboratory evaluation was significant for a leukocytosis (white blood cell count=15.5 K/uL). A complete metabolic panel and urinalysis were within normal limits.\nInitially, testing with point-of-care US was pursued to evaluate for appendicitis or gynecologic causes of pain. Using a high frequency linear array transducer (L8-3 linear array, Zonare Medical Systems Inc., Mountain View, CA, USA) transabdominal US was performed first. However, the appendix was not visualized. Next, a transvaginal US was performed using an E9-4 endocavitary probe (Zonare Medical Systems Inc., Mountain View, California). Findings included a left ovarian complex follicular cyst, small to moderate amount of free fluid, and ovaries with normal arterial and venous blood flow. Additionally, a tender, blind-ended, non-compressible, non-peristalsing, tubular structure measuring 7 mm was noted in the right adnexa consistent with acute appendicitis. A surgical consultation was called and the patient was admitted to the surgical service. The patient underwent laparoscopic resection and pathology confirmed the diagnosis of acute appendicitis.