Presentation
Acute left pelvic pain. Vaginal ultrasound revealed left adenxal heterogeneous mass ? neoplastic ?
Patient Data
Left adenxal (fallobian tube likely ampullary) intraluminal well defined haemorrhagic lesion with rim of sac like peripheral cystic component (representing gestational sac). The lesion shows clear cleavage planes with uterus and ipsilateral left ovary.
Mild pelvic ascites.
Left adenxal (fallobian tube ampullary) intraluminal well defined haemorrhagic lesion with rim of fluid signal (gestational sac) (Red arrow). The lesion shows clear cleavage planes with uterus (star) and ipsilateral left ovary (Yellow chevron).
Case Discussion
MRI findings were impressive of unruptured left 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 (60 mIU/ml). 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 utilised as the first diagnostic method.1
MRI can detect ectopic pregnancy more accurately than CT. Findings include haematosalpinx, ascites with haematic content, and presence of adnexal mass/haematoma, as well as identification of a gestational sac in the adnexal region, with clear cleavage planes with the uterus and ipsilateral ovary. 1
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