Presentation
The patient with known live intrauterine pregnancy presented to emergency room with lower abdominal pain for several hours. The patient denied nausea/vomiting, fever, vaginal bleeding. Gestational age was determined by LMP, which was 11 weeks.
Patient Data
Intrauterine gestational sac is seen, measurements correspond to estimated gestational age of 11 weeks and 2 days. The gestational sac is irregular and elongated in contour. Yolk sac is visualized. Embryo measurements correspond to 11 weeks and 5 days. Cardiac motion is detected, heart rate is 167 beats per minute.
There is a complex cystic lesion within the right ovary, likely representing corpus luteal cyst.
There is an anechoic cystic lesion in the right adnexa, separate from the right ovary, with no significant vascularity. Small circular echogenic structure likely representing a yolk sac is present internally.
Small amount of pelvic free fluid is present in Cul-de-sac.
Case Discussion
The patient's history and physical, laboratory results, and ultrasound findings of second gestational sac in the right adnexa, likely presenting ectopic pregnancy within the fallopian tube, concerning for heterotopic pregnancy.
The patient had a diagnostic laparoscopy, right salpingectomy and removal of ectopic pregnancy. Removed fallopian tube segment was sent for a further analysis. Pathology report showed identifiable fragmented fetal fragments.
Case co-author: Edwin Wang, MD, Diagnostic Radiology Department
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