Article

Ectopic Pregnancy 1

Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Radiology (Impact Factor: 6.87). 12/2007; 245(2):385-97. DOI: 10.1148/radiol.2452061031
Source: PubMed

ABSTRACT

The differential diagnosis in a pregnant patient who presents with pain and bleeding in the first trimester includes normal early pregnancy, spontaneous abortion, molar pregnancy, and ectopic pregnancy. Knowledge of the sonographic appearance of these entities is helpful at arriving at the correct diagnosis. When no intrauterine pregnancy is visualized, careful attention to the adnexa is crucial for finding an extraovarian mass, since the fallopian tube is the most common location for ectopic pregnancy. This review describes and illustrates the sonographic findings of ectopic pregnancy.

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    • "Moreover, the presence of the “ring of fire” on color Doppler imaging, reported in 85–93% of cases as a hypervascular ring of increased flow in the trophoblastic tissue around a mass (especially surrounded by bowel loops), may help differentiate a suspected EP from a corpus luteum cyst. However, both are very well vascularized and both might reveal low-impedance high diastolic flow, similarly to a normal pregnancy [1,5,7]. "
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    ABSTRACT: The rupture of ectopic pregnancy (EP) still remains the primary and direct cause of death in the first trimester of pregnancy. Ultrasonography is known to be a modality of choice in EP diagnostics. We found a severe discrepancy between the frequency of ectopic pregnancies (EP) and the number of available computed tomography (CT) examinations. A 29-year-old woman was admitted to the emergency department with a history of abdominal pain, nausea, vomiting and collapse. Sonographic findings of a suspected EP were unclear. Moreover, not all features of intrauterine pregnancy were present. Due to the patient's life-threatening condition, an emergency multi-slice CT with MPR and VRT reconstructions was performed, revealing symptoms of a ruptured EP. In the right adnexal area, a well-vascularized, solid-cystic abnormal mass lesion was found. Intraperitoneal hemorrhage was confirmed intraoperatively, and the right fallopian tube with a tubal EP was resected. In the surgery in situ, as well as in the pathological examination of the tumor mass, a human embryo of approximately 1.5 cm in length (beginning of the 8(th) week of gestation) was found. Although ultrasonography still remains the first-line imaging examination in EP diagnostics, sometimes the findings of suspected EPs are unclear and not sufficient. The rupture of EP, with serious bleeding and symptoms of shock, may require an emergent pelvic and abdominal CT inspection. A clear correlation was found between the macroscopic CT images and the intraoperatively sampled material.
    Full-text · Article · Oct 2010
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    ABSTRACT: Ectopic pregnancy (EP) is a challenging obstetrical entity in terms of diagnosis both for the clinican and the radiologist. It is still the leading cause of pregnancyrelated morbidity and mortality and fallopian tube is the commonest site of ectopic pregnancy. Incidence of rare forms of EP such as heterotopic and C-section scar EP is increasing because of the high rate of C-section surgeries and increased use of in vitro fertilization. Ultrasonography, combined with serum β-hCG level, is still the most effective radiologic modality in diagnosing EP. Ultrasound and color flow Doppler features of fallopian tube ectopic pregnancy and other rare types of ectopic pregnancies are reviewed and addressed in this article.
    No preview · Article · Jul 2008 · Ultrasound Clinics
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    ABSTRACT: Ectopic pregnancy accounts for approximately 2% of all pregnancies and is the most common cause of pregnancy-related mortality in the first trimester. Initial evaluation consists of hormonal assays and pelvic ultrasonography (US). A history of pelvic pain along with an abnormal beta human chorionic gonadotropin level should trigger an evaluation for an ectopic pregnancy. The fallopian tube is the most common location for an ectopic pregnancy. An adnexal mass that is separate from the ovary and the tubal ring sign are the most common findings of a tubal pregnancy. Other types of ectopic pregnancy include interstitial, cornual, ovarian, cervical, scar, intraabdominal, and heterotopic pregnancy. Interstitial pregnancy occurs when the gestational sac implants in the myometrial segment of the fallopian tube. Cornual pregnancy refers to the implantation of a blastocyst within the cornua of a bicornuate or septate uterus. An ovarian pregnancy occurs when an ovum is fertilized and is retained within the ovary. Cervical pregnancy results from an implantation within the endocervical canal. In a scar pregnancy, implantation takes place within the scar of a prior cesarean section. In an intraabdominal pregnancy, implantation occurs within the intraperitoneal cavity. Heterotopic pregnancy occurs when an intrauterine and an extrauterine pregnancy occur simultaneously. A spectrum of intra- and extrauterine findings may be seen on US images. Although many of the US findings are nonspecific by themselves, when several of them are seen, the specificity of US in depicting an ectopic pregnancy substantially improves.
    Preview · Article · Oct 2008 · Radiographics
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