Ruptured ectopic pregnancy with sentinel clot sign

Case contributed by Dr Prashant Gupta


Acute right iliac fossa pain.

Patient Data

Age: 35 years
Gender: Female

USG showed free fluid in both paracolic gutters with internal echoes. Hyperechoic material seen around uterus (arrows).


CT performed same day.

A correlation NCCT was done in view of acute pain abdomen.

The NCCT shows high density ascites, which in view of acute pain could represent hemoperitoneum or less likely pus.

The density is especially high around the uterus representing the "sentinel clot"- thus most likely hemoperitoneum with a pelvic source.

Also note the "hematocrit" effect with layering in the pelvic free fluid.

Case Discussion

This case was operated shortly after the scan. Per operatively a ruptured right ovarian ectopic was found.

It was not clinically suspected as the patient's history was non-committal.

The sentinel clot helped localize the source and aided the operative management. In absence of this sign, an exploratory laparotomy would have been done which is time consuming.

The sentinel clot sign is usually seen in the setting of trauma and aids to detect the site of possible bleeding, however it can be used in any acute condition with hemoperitoneum.

Further, this case emphasizes that an ectopic pregnancy should be kept in mind in any female patient of child bearing age.  It has also been reported up to 3 years after hysterectomy.

The sentinel clot sign has also been used by forensic radiologists in post mortem CT scans.

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Case information

rID: 17425
Published: 12th Apr 2012
Last edited: 26th Apr 2020
Inclusion in quiz mode: Excluded