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Key Image

Longitudinal gray scale transvaginal sonographic image of the uterus (left side image). Transverse color Doppler transvaginal sonographic image of the left adnexa (right side image).

Key Findings

Transvaginal image through the uterus (white outline) demonstrates no signs of intrauterine pregnancy. The uterus itself appears normal, however is surrounded in echogenic debris (surrounding entire uterus). Also view the dedicated RUQ and LUQ images in the Case Viewer to see more echogenic debris, representing hemorrhage, in the upper abdomen as well.

Transvaginal images through the left adnexa demonstrate echogenic debris and increased vascularity. No definite gestational sac, yolk sac or embryo identified. Left ovarian follicle present. Don't confuse follicles for ectopic pregnancies in the ovaries.

Transabdominal sonographic color Doppler image through the left adnexa demonstrating echogenic debris (hemorrhage) and increased vascularity.

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Diagnosis

Ectopic Pregnancy
Type 3: Ruptured with blood in pelvis

Discussion

Findings associated with Ectopic Pregnancy:
In the setting of no intra uterine pregancy and/or clinical presentation of ectopic pregnacy:

• live embryo seen, but not in the uterus: 100%
• tubal ring: 95%
• complex adnexal mass / hemorrhage: 92%
• normal scan / simple adnexal cyst 5%

Types of Ectopic Pregnancy:

1. unruptured live ectopic + heartbeat
2. early embryonic demise without rupture / embryonic structures / heartbeat
3. ruptured ectopic with blood in pelvis
4. no sonographic signs of ectopic

Note, these types of ectopic pregnancy, correspond with the above associated US findings

Locations for Ectopic Pregnancy:

• Tubal: 96%
• Interstitial: 3%%
• Ovary: 1%
• Cervical, Fimbria, other: rare

Treatment for Ectopic Pregnancy:

• Methotrexate or Surgery
• Surgery required for ruptured ectopics or ectopics measuring > 2.5 cm

References / Resources

Additional Information:

1. Dahnert*: 1054-1056
2. Primer*: 539-540
3. Related Article:

   Lin, EP. "Diagnostic Clues to Ectopic Pregnancy." Radiographics 2008: 28, 1661-1671, Last, FM. "Article." Journal Year: ISSUE, PGS.

   Bolaji, I. "Sonographic Signs in Ectopic Pregnancy: update." Ultrasound 2012: 20-4, 192-210.

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