Out of Bounds' - Imaging Spectrum of Ectopic Pregnancies

This poster was originally presented at the RANZCR Annual Scientific Meeting 2011, October 6-9, in Melbourne/AU.

Congress:

RANZCR ASM 2011

Poster Number:

R-0076

Type:

Educational Exhibit

Keywords:

Obstetrics (Pregnancy / birth / postnatal period), Obstetrics, Genital / Reproductive system female, Ultrasound, Ultrasound-Colour Doppler, Intraoperative, Surgery

Authors:

S. Constantine, W. Hodge; Adelaide/AU

DOI:

10.1594/ranzcr2011/R-0076

DOI-Link:

https://dx.doi.org/10.1594/ranzcr2011/R-0076

Fig. 2: Tubal ring sign. The gestational sac is surrounded by an echogenic rim...

Fig. 3: Ring of fire sign. Colour Doppler US shows increased peripheral vascularity in...

Fig. 4: Peripheral vascularity around a corpus luteum, which can mimic an ectopic...

Learning Objectives

To recognize the various types of ectopic pregnancy on pelvic ultrasound (US).

Background

Ectopic pregnancy is defined as the implantation of a viable pregnancy outside the uterine cavity, and occurs in approximately 2% of pregnancies1,2. It is the leading cause of pregnancy-related death in the first trimester3, and the incidence of ectopic pregnancy has been rising for the past 40 years4,5. The serum beta human chorionic gonadotropin (β-hCG) level usually rises more slowly in an ectopic pregnancy compared with an intra-uterine pregnancy3,4. The serum β-hCG doubles approximately every 48 hours in a normal intra-uterine pregnancy. The clinical triad...

Imaging Findings OR Procedure Details

Ultrasound is an important tool in the diagnosis of ectopic pregnancy, and determining the pregnancy location. An intra-uterine pregnancy should be visible on transvaginal ultrasound (TV US) once the serum β-hCG reaches > 1 000mIU/mL1 to > 3 000mIU/mL4. An intra-uterine pregnancy can be confirmed when a gestational sac containing a yolk sac +/- a fetal pole is demonstrated with US. The diagnosis of an ectopic pregnancy can be made when an extra-uterine pregnancy is identified. If TV US does not identify either an intra-...

Conclusion

It is important for the radiologist to be able to recognize the subtypes of ectopic pregnancy, as the ultrasound diagnosis assists the gynaecologist to plan the appropriate expectant, medical or surgical management of the patient.

Personal Information

Dr Sarah Constantine Perinatal Radiologist Women's and Children's Hospital Adelaide, SA Dr Wendy Hodge Obstetrician and Gynaecologist Women's and Children's Hospital Adelaide, SA

References

Chandrasekhar C. Ectopic pregnancy: a pictorial review. Clin Imaging 2008; 32(6): 468-73. Lin EP, Bhatt S, Dogra VS. Diagnostic clues to ectopic pregnancy. Radiographics 2008; 28(6): 1661-71. Bhatt S, Ghazale H, Dogra VS. Sonographic evaluation of ectopic pregnancy. Radiol Clin North Am 2007; 45(3): 549-60. Seeber BE, Barnhart KT. Suspected ectopic pregnancy. Obstet Gynecol 2006; 107(2 Pt 1): 399-413. Gurel S, Sarikaya B, Gurel K, Akata D. Role of sonography in the diagnosis of ectopic pregnancy. J Clin Ultrasound 2007; 35(9): 509-17. Levine D. Ectopic...