Search
Question
27 year-old G2P1 presents with 3 days of abdominal pain that is mostly suprapubic. Denies any urinary symptoms and vaginal bleeding. Physical examination reveals slight rebound in the right lower quadrant.
An ultrasound revealed the following. What's the diagnosis?
Answer
Pregnancy with Appendicitis
Take Home Points:
- Ultrasound: Outer appendiceal diameter > 6mm and noncompressible supports diagnosis of acute appendicitis
- 100% sensitivity, 68% specificity
- There is no difference in ability for US to diagnosis acute appendicitis between pregnant and non-pregnant women
- Consider MRI for nondiagnostic US
- varying literature shows 92-100% for both sensitivity & specificity
See previous pearl for how to conduct an ultrasound to evaluate for appendicitis.
References
Dewhurst C, Beddy P, Pedrosa I. MRI evaluation of acute appendicitis in pregnancy. J Magn Reson Imaging. 2013;37(3):566-75.
Israel GM, Malguria N, Mccarthy S, Copel J, Weinreb J. MRI vs. ultrasound for suspected appendicitis during pregnancy. J Magn Reson Imaging. 2008;28(2):428-33.
Segev L, Segev Y, Rayman S, Nissan A, Sadot E. The diagnostic performance of ultrasound for acute appendicitis in pregnant and young nonpregnant women: A case-control study. Int J Surg. 2016;34:81-85.
Segev L, Segev Y, Rayman S, Nissan A, Sadot E. Acute Appendicitis During Pregnancy: Different from the Nonpregnant State?. World J Surg. 2016.
Theilen LH, Mellnick VM, Longman RE, et al. Utility of magnetic resonance imaging for suspected appendicitis in pregnant women. Am J Obstet Gynecol. 2015;212(3):345.e1-6.