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March 2010,[object Object],Case 4,[object Object]
Patient History :,[object Object],29 year old female  ,[object Object],LMP : January 11, 2010. ,[object Object],Positive home pregnancy test ,[object Object],Intense back and pelvic pain for twelve hours prior to ,[object Object],presentation.,[object Object]
Exams / Procedures ordered:,[object Object],Pelvic ultrasound February 2010 to evaluate for intrauterine pregnancy versus ectopic pregnancy,[object Object],Status post surgery to remove ectopic pregnancy, CT for increased abdominal pain / pressure.,[object Object]
Ultrasound Findings:,[object Object],Transabdominal ultrasound: ,[object Object],No intrauterine gestational sac visualized. ,[object Object],Moderate amount of free fluid in the cul-de-sac, homogeneous in nature, possibly consistent with hemorrhage.  ,[object Object],Uterus normal in size measuring 4.2 cm x 4.3 cm. ,[object Object],Right ovary is normal in echotexture, size measuring 2.3 cm x 2 cm x 2.6 cm. ,[object Object],Moderate amount of free fluid visualized adjacent to the right kidney.,[object Object],Transvaginal ultrasound:,[object Object],No intrauterine gestational sac visualized. ,[object Object],Moderate amount of free fluid in the cul-de-sac. ,[object Object],Uterus is normal in echotexture and size measuring 8.1 cm in length. ,[object Object],Ovaries are normal in echotexture and size, the left measuring 2.1 cm x 2.8 cm x 3.7 cm and the right measuring 2.2 cm x 2.1 cm x 2.7 cm.  ,[object Object],Follow-up recommendations:,[object Object],Given patient's history of pregnancy with pain and moderate free fluid in the pelvis, ectopic pregnancy is leading differential consideration.  Correlation with beta HCG level and OB/GYN consult is recommended.,[object Object]
Transabdominal Images; uterus and mass,[object Object]
Transvaginal exam images,[object Object]
Fluid accumulation, abdomen,[object Object],Status Post surgical removal of ectopic pregnancy, CT images.,[object Object]
Differential diagnosis,[object Object],Ectopic pregnancy ,[object Object],Ovarian neoplasm ,[object Object],Spontaneous abortion ,[object Object],Blighted ovum ,[object Object],Endometrioma,[object Object],Hydrosalpinx     ,[object Object],Pyosalpinx,[object Object]
Differential diagnosis discussion :,[object Object],Hydrosalpinx, pyosalpinx ruled out by positive pregnancy test.Spontaneous abortion ruled out by positive pregnancy test.Blighted ovum ruled out by lack of intrauterine gestational sac.Endometrioma is ruled out by normal endometrial stripe seen in transvaginal exam.Ovarian neoplasm ruled out by visualization of normal ovaries by transabdominal and transvaginal exams.,[object Object]
Diagnosis:ectopic pregnancy,[object Object],Pathology:,[object Object],[object Object]
95-97% of ectopics are in the fallopian tubes, usually isthmus or ampullary.  Also can be found within the ovary, on the peritoneal surface (abdominal pregnancy), and on the broad ligament.
Incidence of ectopic pregnancy is approximately 70,000 in the United states alone.

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Jackie Dillman Ectopic