Presentation
Lower midline pelvic pain started 2 weeks ago.
Patient Data
A right adnexal complex heterogeneous lesion with adjacent anterior fat plane smudging.
Left ovarian functional cyst.
IUCD is seen in the uterus.
Right adnexal complex heterogeneous lesion eliciting mixed signal with predominant high signal on T1 WI (hemorrhagic signal) and mixed predominantly high signal on T2 with internal low signal. The right ovary is displaced posterior to the lesion.
Left ovarian small simple functional cyst.
Case Discussion
On initial non-contrast CT scan, there was suspected right adenxal complex heterogenous hyperdense lesion with the adjacent anterior omental fat plane smudging which was worrisome for ectopic pregnancy or ruptured ovarian cyst. MRI findings were impressive of right tubal ectopic pregnancy. Upon further questioning, the patient mentioned that she had irregular vaginal bleeding during the past few days. Serum β-hCG was elevated. Her Ob/Gyn physician recommended conservative treatment by methotrexate with a subsequent serial reduction in her serum β-hCG levels. She had an uncomplicated recovery.
Ectopic pregnancy is one of the most common first trimester complications and one of the most frequent causes of presentation of patients with acute abdominal pain to emergency departments. It should be suspected with patients presenting with pelvic pain.
In the emergency setting, computed tomography (CT) and magnetic resonance imaging (MRI) may be utilized as the first diagnostic method.
MRI can detect ectopic pregnancy more accurately than CT. Findings include hematosalpinx, ascites with hematic content, and presence of adnexal mass/hematoma, as well as identification of a gestational sac in the adnexal region, with clear cleavage planes with the uterus and ipsilateral ovary.
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