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Age: 22

Sex: Female

Indication: Right lower quadrant pain, positive pregnancy test

LMP: 7 weeks prior

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Case #14


Findings

  • Cystic structure in the uterus with mean sac diameter of 2.3 cm
  • No fetal pole or yolk sac is visualized
  • Complex fluid in the right adnexa and cul-de-sac
  • Normal appearance of the ovaries


Diagnosis

Ruptured ectopic pregnancy

Sample Report

Complex fluid in the right adnexa and cul-de-sac. In the setting of a positive pregnancy test, this finding raises concern for a ruptured ectopic pregnancy. Recommend urgent gynecologic evaluation.

Cystic structure in the uterus with mean sac diameter of 2.3 cm and surrounding decidual reaction, which may represent a pseudo-gestational sac in the setting of an ectopic pregnancy or a heterotopic pregnancy with findings suspicious for failure of the intrauterine pregnancy.

Normal appearance of the ovaries.


Discussion

  • This was a confirmed case of ruptured ectopic pregnancy, which is the diagnosis of exclusion when a patient with a positive pregnancy test is found to have hemoperitoneum
  • Worry about a pseudo-gestational sac if you see other findings to raise concern for ectopic pregnancy
    • While pseudo-gestational sacs are often more centrally located and may have angular margins in contrast to true gestational sacs, the two are not always easy to differentiate, and in the absence of other findings, a cystic structure in the uterus in a patient with a positive pregnancy test is statistically likely to represent a true gestational sac
    • Ultimately, the development of a yolk sac and fetal pole within a true gestational sac will definitively differentiate the two
    • Close followup imaging should be recommended in equivocal cases



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