Learning objectives
1.
To get familiarwith various unusual sites of pregnancy implantation.
2.
To review the multi-modality imaging features of ectopic pregnancy.
3.
To learn the imaging clues in confidently diagnosing an ectopic pregnancy.
4.
To detect various forms of complication and their further radiological evaluation.
Background
Ectopic pregnancy is the implantation of fertilized ovum outside the uterine endometrial cavity.
Ectopic pregnancy is life-threatening gynecological emergency and a significant cause of maternal morbidity and mortality.
So,
early and accurate diagnosis of ectopic pregnancy is very critical (1).
Although the incidence of ectopic pregnancy is estimated between 1% and 2%,
the majority of these pregnancies are located in the fallopian tube accounting for nearly 95% cases.
However,
about 5% pregnancies implanted in cervix,
ovary,
previous cesarean scar,
interstitial portion of the fallopian tube...
Findings and procedure details
1.Tubal ectopic pregnancy
Ultrasound findings:
Adnexal mass separate from the ovary is very specific sign.
The adnexal mass can be differentiated from the ovary by pressing the mass with one hand while performing transvaginal scan with the other hand.
The visualization of an embryo within the extra-uterine gestational sac directly confirms an ectopic pregnancy,
but this finding is rarely observed.
Tubal ring sign, is hyperechoic ring surrounding an extra uterine gestational sac.
Color Doppler ultrasound may show a peripheral vascularity giving thering of fire sign...
Conclusion
Diagnosis of pregnancies at unusual locations is quite challenging hence timely diagnosis and management helps in decreasing the maternal morbidity and mortality.
The absence of a gestational sac in the uterus and adnexa should prompt a thorough evaluation of other potential sites of implantation,
including the cervix,
cesarean scar,
interstitial fallopian tube,
ovaries,
cul-de-sac,
and abdomen.
Clinical imaging in addition to diagnosing ectopic pregnancy can also provide important information about anatomic relationships for surgical planning.
Radiologists should always consider ectopic pregnancy in the setting of...
Personal information
Dr Nehal Mohamed Saloum.
Clinical Fellow,
Diagnostic Imaging.
Hamad Medical Corporation,
Doha,
Qatar.
Email:
[email protected].
References
1.
Linda Y.
Kao,
et al.
Beyond Ultrasound: CT and MRI of Ectopic Pregnancy. American Journal of Roentgenology.
2014; 202: 904-911.
2.
Sanaa Badr,
et al.
Ectopic pregnancy in uncommon implantation sites.
The.
Egyptian Journal of Radiology and Nuclear Medicine.
2013; 44,
121-130.
3.
Lin EP,
et al.
Diagnostic clues to ectopic pregnancy.
Radiographics.2008; 28:1661-71.
4.
ChananaC.
Different Sonographic Faces of Ectopic Pregnancy.
Journal of Clinical Imaging Science.
2017; 7: 6.
5.
Elizabeth H.
Dibble,
et al.
Imaging Unusual Pregnancy Implantations: Rare Ectopic Pregnancies and...