Ectopic Pregnancy

Niyati Mukherjee

CLINICAL HISTORY

36-year-old female presenting to the emergency department with diffuse abdominal pain. Last menstrual period (LMP) was 9 weeks ago. She recently underwent dilation and curettage (D&C) for suspected ectopic pregnancy with no intrauterine chorionic villi detected during the procedure, and is currently on methotrexate. Transabdominal ultrasound was performed initially; the exam was terminated prior to an attempt at transvaginal ultrasound based on the preliminary findings.

FIGURE 15A

FIGURE 15B

FIGURE 15C

FIGURE 15D

FINDINGS

Figure 15A: Transabdominal US longitudinal image of the uterus. The endometrial stripe is visualized (arrow). No intrauterine pregnancy is identified. Figures 15B and 15C: Transabdominal US longitudinal images of the left adnexa, with and without color Doppler. An echogenic ring with surrounding fluid is seen in the left adnexa (arrow). This is the “tubal ring sign,” worrisome for tubal ectopic pregnancy. Mild vascularity is noted. Normal ovaries are not identified on imaging of the adnexae. Figure 15D: Transabdominal US longitudinal image of the right upper quadrant. Free fluid is seen in the upper abdomen (arrow), as well as the pelvis as seen in Figure 15B, which is worrisome for a ruptured ectopic pregnancy.

DIFFERENTIAL DIAGNOSIS