title: Transvaginal sonography in the diagnosis of acute appendicitis.
abstract: OBJECTIVE
  To evaluate transvaginal sonography with power Doppler capacity in the diagnosis of acute appendicitis and in discriminating appendicitis from pelvic inflammatory disease.
  
  
  METHODS
  We describe transvaginal sonographic findings of six women with acute appendicitis selected from 31 women seen in an emergency room setting for clinically suspected pelvic inflammatory disease. The study population underwent gray-scale transvaginal sonography, and specific sonographic landmark findings for acute appendicitis and pelvic inflammatory disease were used. Hyperemia of any infectious complex was identified by power Doppler. Laparoscopy was performed after transvaginal sonography and was used as the gold standard.
  
  
  RESULTS
  Laparoscopy showed acute appendicitis in six (19%) of the 31 patients. A thick walled non-compressible gas-containing tubular structure with a diameter exceeding 6 mm was seen by transvaginal sonography in four of the six cases, consistent with uncomplicated appendicitis. A heterogeneous complex with surrounding hyperechogenic soft tissue was seen in two cases with gangrenous appendicitis. Power Doppler detected hyperemia in all six cases. Normal adnexal structures were imaged next to the inflamed appendix. The sonographic criteria consistent with acute appendicitis were clearly different from those of acute pelvic inflammatory disease.
  
  
  CONCLUSIONS
  Transvaginal sonography provides an opportunity to distinguish between appendicitis and acute pelvic inflammatory disease. Prospective trials are needed in order to evaluate the impact of transvaginal sonography in the diagnosis of acute appendicitis.
authors.affiliation: Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland. pontus.molander@hus.fi
authors.forename: P
authors.initials: P
authors.lastname: Molander
authors.forename: J
authors.initials: J
authors.lastname: Paavonen
authors.forename: J
authors.initials: J
authors.lastname: Sjöberg
authors.forename: L
authors.initials: L
authors.lastname: Savelli
authors.forename: B
authors.initials: B
authors.lastname: Cacciatore
mesh_terms: D000208:Acute Disease; D000328:Adult; D001064:Appendicitis / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D004630:Emergencies; D005260:Female; D006801:Humans; D000292:Pelvic Inflammatory Disease / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler / Q000379:methods