(Image #1 and Image #2)
(Image #1 and Image #2)
Findings: Image #1 is a transvaginal ultrasound of the uterus demonstrating the uterus to be in a retroflexed position. The endometrial stripe is thin and there is no evidence for IUP. Image #2 is a transvaginal ultrasound of the left adnexa demonstrating an ectopic gestational sac with a fetal pole measuring approximately 8 mm.
Diagnosis: Ectopic pregnancy.
Discussion: Ectopic pregnancy is the implantation and growth of products of conception outside the normal uterine cavity. It is a significant cause of morbidity and mortality. Patients classically present with the clinical triad of pain, hemorrhage, and palpable adnexal mass, although none of these are specific for ectopic pregnancy. Risk factors include prior ectopic, IUD, history of PID, prior tubal surgery, and in-vitro fertilization as well as fertility medications. Ectopic pregnancies are most often located within the fallopian tube, but other potential sites include interstitial (cornual), ovarian, cervical, and fimbrial. Transvaginal ultrasound should be used in the evaluation of patients at risk, especially for those in whom there has been no identification of an IUP with transabdominal ultrasound. With ectopic pregnancy, the uterus is most commonly normal, but may contain a pseudosac, which will fill the endometrial canal symmetrically as opposed to a gestational sac, which is usually asymmetric. If an intrauterine fluid collection is identified, but no fetal pole or yolk sac is seen, then the differentials include: 1) ectopic pregnancy with pseudosac, 2) IUP too early to identify the yolk sac, 3) abnormal IUP. In any case, further evaluation of the adnexa is warranted. Adnexal findings associated with ectopic pregnancy include: tubal ring sign, complex adnexal mass, simple adnexal cyst, and free fluid in the cul-de-sac. It is important to note that a normal transvaginal ultrasound exam does not exclude the presence of an ectopic pregnancy.
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