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HISTORY: A 22-year-old female presented with severe right lower quadrant pain, nausea, and vomiting
FIGURE 4.25.1 FIGURE 4.25.2
FIGURE 4.25.3
FINDINGS: Transvaginal scan, sagittal image DISCUSSION: The incidence of ectopic pregnancy
through the uterus (Fig. 4.25.1) shows normal endo- has increased in recent years and is seen in 1%
metrial stripe without any intrauterine gestational to 2% of all pregnancies in United States (44–46). It
sac. There is significant amount of free fluid noted most commonly occurs in fallopian tubes (97%) but
posterior to the uterus. Figure 4.25.2 through the can occur in cervix, ovary, cornua of the uterus or
right adnexa shows a large anechoic cystic mass even intra-abdominally. Among the tubal pregnan-
(O), which represents right ovary with corpus luteal cies, ampulla is the most common site of implanta-
cyst. Anterior to that, there is an echogenic ring-like tion. If the patient’s beta-hCG is more than 1,500
structure (short arrows) that represents an extrauter- to 2,000 mIU/mL and an intrauterine pregnancy is
ine gestational sac. A small yolk sac (long arrow) is not seen on a transvaginal scan, an ectopic preg-
also present within the gestation sac. Figure 4.25.3 nancy should be suspected (New9). Patients usually
is a color Doppler US image through the right ad- present with lower abdominal pain. The risk fac-
nexal region showing increased vascularity around tors include previous tubal surgery, previous ectopic
the gestational sac. pregnancy, infertility treatment, and intrauterine
contraceptive device. On ultrasound, tubal preg-
DIAGNOSIS: Right ectopic pregnancy nancy usually presents as a complex adnexal mass,
4 / ULTRASOUND 217