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Ectopic Pregnancy Part 4

March 10, 2009
Written by: , Filed in: Obstetric Ultrasound
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It isn’t until we come to the third position that we run into ectopic pregnancies and finally, patients who have a spontaneous abortion.

If we turn our attention from excluding ectopic pregnancy by the identification of intrauterine pregnancy, and instead look at the criteria to diagnose an ectopic pregnancy, we find that there are two finding, free fluid and an adnexal mass.

The adnexal mass has a variety of appearances. Remember that if you saw no intrauterine pregnancy and the patient was an at risk patient, that circumstance brought her risk up to greater than 50/50.

If in addition you see pelvic fluid, her risk jumps up to 75%.

So, here we have a transabdominal sonogram in an at risk woman in whom we see no intrauterine pregnancy and fluid in her cul de sac so she’s at about a 75% risk of an ectopic pregnancy.

If we see a mass in that group of women, than her risk jumps again to about 75%. So either fluid or a mass increases the risk about 75%.

So here we have a transabdominal sonogram showing an empty uterus and an adnexal mass in the right adnexa that is highly suspicious.

Here on an endovaginal sonogram, we see this typical mass identified in an ectopic pregnancy patient, which is a mass of mixed echogenicity.

These are almost always hematosalpinges, this one with fresh blood and a little bit older blood.

Here is a woman where the mass in the tube is more hypoechoic. This is usually a somewhat older blood clot in the tube. Obviously, if we actually see an adnexal embryo, we can be 100% certain that the patient has an ectopic pregnancy.

Unfortunately that is seen in only 15% to 35% of patients who have an ectopic pregnancy.

So if you see a yolk sac, an embryo without a heartbeat, or an embryo with a heartbeat in the adnexa, you can confidently diagnose ectopic pregnancy.

In Ectopic Pregnancy Part V, we will look at the issue of the large ectopic pregnancy.

Author: Roy A. Filly, MD
Excerpted from:
Diagnostic Imaging Review: For Residents, Fellows and Radiologists
Female Pelvis Section

Women’s and Breast Imaging

New York University Post-Graduate Medical School and the Department of Radiology This course is designed for the practicing radiologist with particular interest in women’s imaging and breast imaging. During the women’s imaging segment, the participating faculty will discuss each of the imaging modalities applied to obstetrical and gynecological imaging including ultrasound, MRI and CT. Practical and multimodality approaches to common imaging problems in the female pelvis will be emphasized, including imaging of the patient with pelvic pain, evaluation of adnexal masses and assessment of benign and malignant disorders of the uterus. Topics in obstetrical imaging will include requirements for the sonographic fetal anatomic survey, sonographic evaluation of obstetrical emergencies, normal and abnormal first trimester pregnancy and imaging pitfalls. The role of MR and CT in the evaluation of the pregnant patient will also be discussed. Click here to read more or order: Women’s and Breast Imaging

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