Presentation
Past history of a ruptured ovarian cyst. Severe right lower abdominal pain.
Patient Data
Transabdominal US of the pelvis including the right iliac fossa was normal, therefore transvaginal imaging was performed.
![](https://prod-images-static.radiopaedia.org/images/1642595/24284d60dc67d68cab6814c5b77dba10c45b75f16bb17d7a9c2200667acb6392_thumb.jpeg)
![](https://prod-images-static.radiopaedia.org/images/1642602/fe734cd73d409dd8c510ca45b332e90823515a52daa3e9a574f44c91b350f834_thumb.jpeg)
![](https://prod-images-static.radiopaedia.org/images/1642609/f34fd4bb589cbe2b88bc290a1594b30598ddbce8cf231c40860054efbfa64bfc_thumb.jpeg)
![](https://prod-images-static.radiopaedia.org/images/1642595/24284d60dc67d68cab6814c5b77dba10c45b75f16bb17d7a9c2200667acb6392_big_gallery.jpeg)
Right adnexal tender, fluid-filled, blind-ending tubular mass with surrounding free fluid. Increased blood flow in the wall of the tubular structure adjacent to iliac vessels.
Case Discussion
Despite this being a transvaginal examination, appearances are all consistent with acute appendicitis. Differential diagnosis is acute salpingitis but the tubular structure is blind-ending and not associated with the ovary.