Presentation
The patient presented to emergency room with cramping lower abdominal pain, increased abdominal girth, vaginal spotting for a month. Denies passage of clots, fever, nausea, or vomiting. HCG levels were obtained and came back positive.
Patient Data
No intrauterine gestational sac. Left adnexal/left fallopian tube gestational sac with fetal pole and cardiac activity (8 weeks and 4 days gestational age by CRL), which appears separable from the left ovary. Moderate amount of the complex pelvic fluid.
There is corpus luteum cyst in the left ovary.
Case Discussion
The patient presentation, history and physical, positive HCG levels, and ultrasound findings are compatible with live left adnexal/tubal ectopic pregnancy. Based on the high level of HCG (around 150000), size of the gestational sac, and suspected hemoperitoneum surgical treatment was ordered.
The patient had laparoscopic left salpingectomy with removal of ectopic pregnancy. Surgical report revealed hemoperitoneum with an adherent clot on a large, egg-sized ectopic pregnancy of the left fallopian tube (involved the fimbria).
Case co-author: Yekaterina Kucerova, MD, Diagnostic Radiology Department
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