Ruptured tubal ectopic pregnancy

Case contributed by Gihan Wijetunga
Diagnosis certain


Abdominal pain and vaginal bleeding. 6 week history of amenorrhea with a positive home pregnancy test.

Patient Data

Age: 30 years
Gender: Female

Decidual reaction of the endometrium

  • no intrauterine pregnancy seen – no gestational sac

  • moderate to large volume complex (internal echoes seen on US) free fluid in the pouch of Douglas

  • maximum probe tenderness over the right adnexa

  • adjacent to right ovary is a “donut” shaped hyperechoic lesion with peripheral vascularity and minor surrounding free fluid

  • the ovaries are both normal in appearance with scattered small follicles seen bilaterally

Appearances and findings are most suggestive of a ruptured ectopic pregnancy.

Case Discussion

The patient describes the pain as sharp, one-sided, and located in the lower abdomen. The pain has been worsening over the past few days and is now associated with some shoulder tip pain. On physical examination, she appears pale and uncomfortable. Her blood pressure is 100/60 mmHg, heart rate is 110 beats per minute, and her abdomen is tender to palpation, especially on the right side.

The patient proceeded to laparoscopy and right salpingectomy. Diagnosis confirmed on pathology.

This is a classic case of a ruptured ectopic pregnancy. It is important for both the sonographer and radiologist to maintain a high index of suspicion when a patient is pregnant and the ultrasound shows no gestational sac in the uterus.

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