Ruptured tubal heterotopic pregnancy (MRI)

Case contributed by Dr Vikas Shah

Presentation

7/40 pregnant, acute lower abdominal pain.

Patient Data

Age: 30 years
Gender: Female

Intrauterine gestation sac and normal ovaries, including simple right ovarian cysts, noted. Superior to the right ovary, there is a heterogeneous mass measuring 5 cm in diameter. A large volume of free fluid is present throughout the abdomen, with heterogeneous signal fluid in the anterior pelvis being fresh blood. Normal appendix and remaining bowel.

Appearances are consistent with a right tubal mass, and given the large volume of free fluid, this may be a heterotopic pregnancy with tubal rupture.

Histopathology

Clinical Details: Right tubal ectopic, right ruptured.

Macroscopic: Dilated Fallopian tube measuring 50 x 10 x 10mm and a separate piece ?fimbrial end measuring 50 x 40 x 5mm. No foetal parts or vesicles identified. 

Microscopic: This specimen consists of a Fallopian tube associated with blood clot and chorionic villi. Part of the implantation site is identified. There is no evidence of gestational trophoblastic disease. These appearances are in keeping with the clinical history of a ruptured tubal ectopic pregnancy.

Conclusion: Right Fallopian tube - ruptured tubal ectopic pregnancy confirmed.

Case Discussion

The right tubal mass was confirmed at histopathology analysis to be a heterotopic pregnancy with rupture leading to a hemoperitoneum. 

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