Presentation
Lower abdominal pain for 3 days. No constipation or urinary symptoms
Patient Data
Well-circumscribed hypervascular left adnexal mass with prominent vessels extending to the left fallopian tube and uterus. The adnexal mass is separate from bowel loops and there is no associated tethering of bowel loops adjacent to the mass. Fluid-filled uterus with hyperenhancing endometrium. Minimal fluid in pelvis and pouch of Douglas but no hemoperitoneum. No kidney in either renal fossa associated with absent renal arteries arising from the aorta at their expected take-off and elongated adrenal glands ("lying down adrenal sign"). Incidental malrotated pelvic kidney but no hydroureteronephrosis.
The annotated image shows a black arrow denoting the ectopic pregnancy within the left adnexal region. The lower arrow points to the malrotated pelvic kidney.
The patient subsequently had surgery with a histological specimen-
Macroscopy: Specimen consists of multiple grey-brown fragments of tissue, largest measuring 72 mm x 34 mm x 17mm. No fetal parts were seen.
Microscopy:
Sections of the fallopian tube wall show decidualisation, chronic villi, trophoblastic cells and hematoma. No evidence of gestational trophoblastic disease or fetal parts.
Pathological diagnosis: Left tubal salpingectomy with tubal ectopic pregnancy
Case Discussion
The CT demonstrates a hypervascular left adnexal/fallopian tube mass which is similar to the "ring of fire sign" commonly observed on ultrasound. The patient underwent surgery. Incidental pelvic kidney noted. Differential diagnosis would include a normal corpus luteum and hypervascular adnexal neoplasm. Renal agenesis results from disorders of the ureteric bud which is also associated with Wofflian and Mullerian duct abnormalities which result in genitourinary abnormalities.
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