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Pelvic discomfort, elevated bHCG
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Adnexal mass with "ring of fire" vascularity adjacent to, but external to the left ovary. The appearance in the setting of elevated bHCG almost certainly represents an ectopic pregnancy. Small volume anechoic free fluid near the left adnexa.
No intrauterine gestational sac is seen, but note a sliver of fluid within the endometrial cavity and a secretory endometrium.
Typical appearance of a probable tubal ectopic pregnancy.
On imaging alone, the presence of an adnexal mass with rim vascularity in the presence of a raised bHCG is considered to represent a probable ectopic pregnancy with 95% risk. If a yolk sac or fetal pole were seen (which in this case they are not), it would be regarded as a definite (100%) ectopic.