Interstitial ectopic pregnancy

Case contributed by A.Prof Frank Gaillard

Presentation

This patient presented with abdominal pain, 7 weeks and 5 days since the last menstrual period. The beta-hCG was elevated.

Patient Data

Gender: Female
Modality: Ultrasound

An off-midline sagittal transvaginal ultrasound image of the uterus demonstrates an echogenic rounded structure in the region of the uterine cornu (towards fundus and eccentrically placed). The distance from the edge of the echogenic area to the serosal surface of the uterus is 1.4 mm. 

Case Discussion

Interstitial ectopic pregnancy (sometimes called cornual) occurs in the interstitial portion of the fallopian tube. It accounts for 2-4% of all ectopics. The morbidity and mortality are higher due to later presentation, and the tendency to massive haemorrhage.

The diagnosis is suggested by visualisation of an intrauterine gestational sac or decidual reaction located high in the fundus, that is not surrounded by more than 5 mm of myometrium in all planes.

An interstitial line sign - an echogenic line from the mass to the endometrial echo complex reportedly has high sensitivity (80%) and specificity (98%).

Management of interstitial ectopic includes methotrexate (either systemic or local), potassium chloride injection, conservative laparoscopic surgery, uterine artery embolisation, cornuectomy or hysterectomy. The latter two are usually reserved for the emergency case or for failure of other methods.

Image contributed by: Dr Laughlin Dawes.

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Case Information

rID: 36010
Case created: 24th Apr 2015
Last edited: 29th Nov 2015
System: Obstetrics
Inclusion in quiz mode: Included

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