We present a case of a female patient with right lower quadrant abdominal pain, in whom transvaginal ultrasound facilitated the diagnosis of acute appendicitis. The insertion of the appendix into the cecum was demonstrated with direct continuity between the cecal lumen and the appendix. The inflamed appendix was in close proximity to the right ovary and was distinguished by a thick edematous wall and fluid in the lumen. This combination of findings may comprise a new sonographic sign for the diagnosis of acute appendicitis, particularly when performed by transvaginal sonography.