Ectopic pregnancy

Case contributed by Dr Naim K

Presentation

Lower abdominal pain with tenderness at the suprapubic region and left iliac fossa.

Patient Data

Age: 30 years
Gender: Female
Ultrasound

3 x 4 cm heterogeneous lesion that is predominantly solid with cystic components in the left iliac fossa. There is a hyperemic rim adjacent to the distal colon. The origin of this lesion is not clear and could be an inflammatory process. CT scan was advised for better evaluation.

The uterus and both ovaries appear unremarkable.

IUCD in situ.

The rest of the abdominal and pelvic ultrasound examination was unremarkable.

CT

Heterogeneously enhancing complex mass lesion in the left adnexal region extending to the left iliac fossa close to the uterus consistent most likely with a complex left ovarian mass.

The uterus contains IUCD but otherwise appears normal.

No evidence of right adnexal masses or free pelvic fluid.

No evidence of abdominal masses, lymph node enlargement, or fluid collections.

The rest of the examination appears unremarkable.

Case Discussion

This 30-year-old lady presented through the ER with lower abdominal pain. Physical examination demonstrated tenderness at the suprapubic region and left iliac fossa. Ultrasound of the abdomen and pelvis was requested demonstrating heterogeneous lesion at the left iliac fossa predominantly solid and hypervascular on Doppler examination was thought about this lesion to be inflammatory in nature. Further evaluation by CT with IV contrast was requested by the treating team and demonstrated heterogeneously enhancing lesion likely arising from the left ovary. Laboratory results did not show the normal doubling of serum beta HCG levels and the diagnosis of ectopic pregnancy was made.

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