Presentation
Spotting blood per vagina for 3 weeks, followed by 2 days of heavy vaginal bleeding. Crampy lower abdominal pain and diarrhea.
Patient Data
anteverted uterus of normal, non-pregnant size
no gestational sac within the endometrial cavity
right-sided corpus luteum
-
~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 is 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 a 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 a serial bHCG follow-up.