The need for imaging will be determined by the suspected pathology. In most cases, a transvaginal ultrasound will be essential.
The pathological conditions that an ultrasound may detect are:
- ovarian cyst haemorrhage
- ovarian cyst torsion (although ultrasound features are not specific or sensitive)
- free fluid in POD
- tubo-ovarian abscess
The 'target sign' has been described as the criteria for ultrasound diagnosis of appendicitis. It appears as a sausage-shaped, aperistaltic, hypoechoic structure when imaged along its longitudinal axis, with a target-like appearance on transverse section. There is no consensus as to whether all women with suspected appendicitis should undergo routine ultrasound assessment or gynaecological review.
An appendix abscess appears as an echogenic mass on ultrasound.
In suspected bowel pathology, for example diverticulitis or diverticular abscess, a CT scan may be appropriate. It is also indicated in cases of suspected bowel obstruction.