Presentation
Vaginal bleeding, lower abdominal pain, amenorrhea, and positive pregnancy test.
Patient Data
Transvaginal ultrasound reveals a normal uterus with a trilaminar secretory phase appearance. Both ovaries appear normal.
A left adnexal complex mass measuring 4.3 x 3.4 cm is suggestive of a hematoma. Additionally, echogenic free fluid in the cul-de-sac is indicative of blood.
Case Discussion
The patient presented to the emergency department with severe lower abdominal pain and vaginal bleeding. A qualitative pregnancy test showed a positive result.
While an adnexal hematoma is a common finding, it is also the least specific for ectopic pregnancy. The presence of an extra-ovarian adnexal mass in a patient with an empty uterus and a serum β-hCG level above the discriminatory level for visualizing an intrauterine pregnancy has been reported to be 84% sensitive and 99% specific for the diagnosis of ectopic pregnancy.
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