Appendicitis Diagnosed by Emergency Physician Performed Point-of-Care Transvaginal Ultrasound

Case Series

Robert Bramante, MD; Marek Radomski, DO; Mathew Nelson, DO; Christopher Raio, MD


Western J Emerg Med. 2013;14(5):415-418. 

In This Article

Abstract and Introduction


Lower abdominal pain in females of reproductive age continues to be a diagnostic dilemma for the emergency physician (EP). Point-of-care ultrasound (US) allows for rapid, accurate, and safe evaluation of abdominal and pelvic pain in both the pregnant and non-pregnant patient. We present 3 cases of females presenting with right lower quadrant and adnexal tenderness where transvaginal ultrasonography revealed acute appendicitis. The discussion focuses on the use of EP- performed transvaginal US in gynecologic and intra-abdominal pathology and discusses the use of a staged approach to evaluation using US and computed tomography, as indicated.


Acute abdominal pain in female patients of reproductive age continues to present a diagnostic challenge for the emergency physician (EP). Abdominal pain accounts for 10% of all emergency department (ED) visits, and the abdominal and pelvic examinations are notoriously unreliable for differentiating between gynecologic and intraabdominal pathology.[1–3] Multiple advanced imaging and diagnostic options may be used to evaluate medical, surgical, or gynecologic pathology. Point-of-care ultrasound (US) allows for the rapid, accurate and safe differentiation of multiple diagnoses in the ED.[4–6] We present 3 cases of acute appendicitis diagnosed by EP point-of-care transvaginal ultrasonography.