Presentation
Abdominal pain and hypotensive.
Patient Data
Large volume echogenic free fluid is present in the pelvis, particularly in the region of the right adnexa, in keeping with hemoperitoneum.
In the right adnexa, a gestational sac is present, up to 2.1 cm in maximal dimension, with a fetal pole evident. No definite fetal heart beat identified on Doppler M-mode assessment. The right ovary was difficult to identify, due to the large amount of adjacent hemoperitoneum. The left ovary was also not well seen. The uterus is anteverted, with a small amount of echogenic fluid/blood in the endometrial cavity. No definite intrauterine gestation was identified.
Case Discussion
This patient had a bHCG of 11670. The ultrasound findings are in keeping with a ruptured right adnexal, most likely tubal, ectopic pregnancy, with moderate to large hemoperitoneum.
The findings were discussed with the ED referring doctor and the patient was sent for urgent gynecological review.