Interactive Transcript
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This is an MRI of the abdomen and pelvis in
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a patient with an abnormal pelvic ultrasound
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and significant vaginal bleeding in the
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context of a positive home pregnancy test.
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Her initial pelvic ultrasound
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evaluation was limited by the
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presence of numerous uterine fibroids.
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which we can see on this coronal T2-weighted
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image as multiple well-circumscribed T2 hypo-
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intense lesions within the uterine myometrium.
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Axial T2-weighted images of the
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abdomen and pelvis are present
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on the left side of the screen.
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Again, we see multiple T2
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dark uterine fibroids present.
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As we scroll inferiorly, we see the endometrial
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cavity, which is T2 bright, and a small
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amount of surrounding junctional zone.
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We also see a uterine fibroid, which
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is somewhat exophytic and is likely
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undergoing hyaline degeneration internally.
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In the region of the cervix, we see
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a heterogeneously T2 hyperintense
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lesion with a central cystic focus.
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This is a gestational sac centered within
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the cervix with surrounding early chorionic
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proliferation and placental development.
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End.
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The T2 dark focus that we see within
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a gestational sac is the embryo.
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On the coronal T2-weighted images, again, we see
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multiple well-circumscribed uterine fibroids.
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In the region of the cervix, we see
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heterogeneously T2 hyperintense tissue
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with a central cystic focus, which we now
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know is the amniotic sac or gestational sac.
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We see the embryo within the central aspect
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of the gestational sac, and again, this
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heterogeneous tissue within the cervix
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is early chorionic proliferation
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and placental development.
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Lastly, let's evaluate the sagittal T2-
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weighted images of the pelvis for this patient.
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Again, we see multiple uterine
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fibroids with a posteriorly located and
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mildly compressed endometrial cavity.
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Within the region of the cervix, it's very
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difficult on the sagittal to define the
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anterior and posterior lip, although perhaps
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we see a bit of the cervical canal here.
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The bulk of this early chorionic tissue is
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centered within the posterior lip of the
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cervix, with the gestational sac centrally.
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This patient is at significant risk for
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severe bleeding in the context of this ectopic
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pregnancy, which is cervical in location.
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This patient was taken to surgery,
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which confirmed a diagnosis
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of cervical ectopic pregnancy.
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