UMEM Educational Pearls

Title: What's the Diagnosis? Case by Dr. Harry Achterberg

Posted: 12/5/2016 by Tu Carol Nguyen, DO
Click here to contact Tu Carol Nguyen, DO

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.