Differential Diagnosis: Pelvic Inflammatory Disease

Pelvic inflammatory disease mimicking appendicitis.

20 year old non-pregnant, sexually active female presented to the emergency department with right lower quadrant pain. Pelvic examination revealed cervical motion tenderness. The patient was afebrile, and there was no leukocytosis. Right lower quadrant and pelvic ultrasound shown below was performed to differentiate between appendicitis and pelvic inflammatory disease.

Transabdominal pelvic ultrasound in the transverse plane shows a thick-walled mass in the right adnexa (arrows), thought to represent a tubo-ovarian abscess. U = uterus; B = urinary bladder. Graded compression examination (not shown) failed to reveal an abnormal appendix.
The patient's symptoms improved with three days of intravenous antibiotics. She was discharged home with a presumptive diagnosis of pelvic inflammatory disease.

Return to Differential Diagnosis