Acute Appendicitis

Abstract

Appendicitis is the most common cause of acute abdominal pain requiring surgery. Approximately 250,000 appendectomies are performed annually in the United States. Sonography and computed tomography have both proven to be reliable imaging options for evaluating patients presenting with right lower quadrant pain and possible appendicitis. The authors report a case of acute appendicitis incidentally discovered during routine transvaginal sonography (TVS). Although TVS is not the standard imaging technique for evaluating the acute appendix, it is important for sonographers and sonologists to recognize the pathology when it is encountered and the value of the transvaginal approach.A woman in her early 20s was referred for a pelvic sonogram to rule out an ovarian cyst. The patient complained of pain in the right lower quadrant and nausea. Transabdominal and transvaginal imaging of the pelvis was performed on an Acuson Sequoia 512 (Acuson Corporation, Mountain View, CA). Transvaginal sonography (TVS) demonstrated a sonographically normal uterus and left ovary. The right ovary contained a 3-cm cyst with internal echoes. Free intraperitoneal fluid was present in the posterior cul-de-sac.In the right adnexa, a tubular, blind-ended mass with a gut signature was identified (Fig. 1). The mass measured greater than 8 mm in anteriorposterior diameter (Fig. 2). No peristaltic motion was observed on real-time imaging. These findings were considered suspicious for acute appendicitis. Color Doppler imaging (Fig. 3) showed evidence of hyperemic vascular flow in the wall of the appendix. The patient was admitted for a surgical appendectomy. Pathology reported a grossly enlarged appendix. Microscopic evaluation revealed neutrophilic exudation involving the mucosa and