Presentation
Abdominal pain and vaginal bleeding. 6 week history of amenorrhea with a positive home pregnancy test.
Patient Data
Decidual reaction of the endometrium
no intrauterine pregnancy seen – no gestational sac
moderate to large volume complex (internal echoes seen on US) free fluid in the pouch of Douglas
maximum probe tenderness over the right adnexa
adjacent to right ovary is a “donut” shaped hyperechoic lesion with peripheral vascularity and minor surrounding free fluid
the ovaries are both normal in appearance with scattered small follicles seen bilaterally
Appearances and findings are most suggestive of a ruptured ectopic pregnancy.
Case Discussion
The patient describes the pain as sharp, one-sided, and located in the lower abdomen. The pain has been worsening over the past few days and is now associated with some shoulder tip pain. On physical examination, she appears pale and uncomfortable. Her blood pressure is 100/60 mmHg, heart rate is 110 beats per minute, and her abdomen is tender to palpation, especially on the right side.
The patient proceeded to laparoscopy and right salpingectomy. Diagnosis confirmed on pathology.
This is a classic case of a ruptured ectopic pregnancy. It is important for both the sonographer and radiologist to maintain a high index of suspicion when a patient is pregnant and the ultrasound shows no gestational sac in the uterus.
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