Interstitial ectopic pregnancy

Case contributed by Dr Matthew Lukies

Presentation

Spotting blood per vagina for 3 weeks, then 2 days of heavy PV bleed. Crampy lower abdominal pain and diarrhea.

Patient Data

Age: 40 years
Gender: Female
Ultrasound
  • anteverted uterus of normal non-pregnant size
  • no gestational sac within the endometrial cavity
  • right-sided corpus luteum
  • approximately 2 cm rounded hyperechoic focus with a thin line of communication back to the endometrium
    • there is a very thin amount of myometrium overlying the hyperechoic focus
  • the left ovary is unremarkable
  • no free fluid seen in the pelvis

Case Discussion

This case is a typical demonstration of an interstitial ectopic pregnancy, with a thin surrounding myometrial layer (myometrial mantle) and hyperechoic line from the mass to the endometrium (interstitial line sign).

The patient in this case was not on the oral contraceptive pill and had a bHCG of 1300. She was treated with IM methotrexate and serial bHCG follow up.

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