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Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Continuing Medical Education (State CME)
Complete all of your state CME requirements in one convenient place.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Case Crunch: Rapid Case Review (Free)
Register for free live board reviews.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
Pediatric Imaging
For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Compliance
NewTrack, fulfill, and report on all your radiologists' credentialing and licensing requirements.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
1 topic, 3 min.
3 topics, 3 min.
4 topics, 7 min.
3 topics, 8 min.
12 topics, 23 min.
Introduction: Normal Pregnancy
2 m.First Trimester US
4 m.Second/Third Trimester US
3 m.First Trimester MR (7 weeks)
3 m.First Trimester MR (10 weeks)
2 m.Second/Third Trimester MR
2 m.Third Trimester MR
2 m.Second/Third Trimester CT
2 m.Multiple Gestations (MRI) Dichorionic Triplets
2 m.Multiple Gestations (MRI) Twins
3 m.Multiple Gestations (CT)
2 m.Summary: Multimodal Imaging of Normal Pregnancy
2 m.9 topics, 29 min.
Introduction: Abdominopelvic Pathology During Pregnancy
3 m.Appendicitis
4 m.Hepatitis
3 m.Acute Deep Venous Thrombosis
2 m.Adnexal Mass
2 m.Second Trimester Pregnancy with Bilateral Adnexal Masses (Teratomas)
5 m.Ovarian Torsion MR
3 m.Ovarian Torsion US
4 m.Summary: Acute Abdominopelvic Pathology During Pregnancy
9 m.9 topics, 36 min.
10 topics, 23 min.
Introduction: Ectopic Pregnancy
2 m.Tubal Ectopic Pregnancy
3 m.Ruptured Tubal Ectopic CT
3 m.Ruptured Tubal Ectopic US
4 m.Cervical Ectopic Pregnancy
3 m.Intra-Abdominal Ectopic Pregnancy
4 m.Interstitial Ectopic MR
2 m.Interstitial Ectopic US
3 m.Cesarean Section Scar Ectopic
3 m.Summary: Ectopic Pregnancy
1 m.4 topics, 13 min.
0:00
This is a CTA of the abdomen and
0:02
pelvis in a patient presenting with
0:05
acute onset right-sided pelvic pain.
0:09
When she came to the emergency department,
0:11
her blood pressure was lower than expected
0:13
for a patient of her age, and so they
0:16
performed a FAST exam, which is an ultrasound
0:18
survey of the abdominal quadrants.
0:20
The FAST exam was positive for hemoperitoneum,
0:23
and so despite a pending beta-HCG,
0:26
the patient was sent for CTA of the abdomen and
0:28
pelvis to further evaluate a source of bleeding.
0:32
Arterial phase CT images are on the left
0:34
side of the screen, and venous phase CT
0:36
images are on the right side of the screen.
0:40
Immediately as we enter the upper
0:42
abdominal quadrants, we can see a
0:44
significant amount of low-density free
0:47
fluid surrounding the liver and spleen.
0:50
If we draw a region of interest on this fluid,
0:53
we can see that the internal attenuation is 37
0:56
HU units, which is indicative of hemoperitoneum
0:59
and confirms the findings at the FAST exam.
1:03
As we scroll into the pelvis, we see
1:05
a significant amount of hemoperitoneum
1:07
layering along the right greater
1:09
than left pericolic gutters as well.
1:14
As we enter the pelvis, we see
1:16
clotted blood products which are
1:18
intermixed with the adjacent bowel.
1:21
The uterus is best visualized on the
1:24
venous phase images, and we can see a normal
1:26
appearing uterus which is minimally enlarged,
1:30
with a normal appearing endometrial cavity.
1:34
In the right adnexa, there is a
1:37
markedly peripherally enhancing
1:39
structure with central hypoattenuation.
1:43
And what's important to note
1:44
about this structure is the
1:45
degree of peripheral vascularity.
1:48
We can also see a significant
1:49
amount of recruited vasculature
1:51
extending toward this structure.
1:55
On the venous phase images adjacent to this
1:57
structure, we can visualize the normal right
2:00
ovary, which has a corpus luteum within it.
2:04
The left ovary is also
2:05
visualized in the left adnexa.
2:07
So we have an extra-ovarian peripherally
2:10
enhancing structure in the right adnexa
2:12
with a significant amount of pelvic
2:14
hemoperitoneum, with hemoperitoneum
2:17
extending into the upper abdominal quadrants.
2:20
Given the clinical history and the appearance
2:22
of the imaging findings, concern was
2:24
raised for a ruptured ectopic pregnancy.
2:27
The patient was taken to the OR,
2:28
which confirmed the diagnosis.
Interactive Transcript
0:00
This is a CTA of the abdomen and
0:02
pelvis in a patient presenting with
0:05
acute onset right-sided pelvic pain.
0:09
When she came to the emergency department,
0:11
her blood pressure was lower than expected
0:13
for a patient of her age, and so they
0:16
performed a FAST exam, which is an ultrasound
0:18
survey of the abdominal quadrants.
0:20
The FAST exam was positive for hemoperitoneum,
0:23
and so despite a pending beta-HCG,
0:26
the patient was sent for CTA of the abdomen and
0:28
pelvis to further evaluate a source of bleeding.
0:32
Arterial phase CT images are on the left
0:34
side of the screen, and venous phase CT
0:36
images are on the right side of the screen.
0:40
Immediately as we enter the upper
0:42
abdominal quadrants, we can see a
0:44
significant amount of low-density free
0:47
fluid surrounding the liver and spleen.
0:50
If we draw a region of interest on this fluid,
0:53
we can see that the internal attenuation is 37
0:56
HU units, which is indicative of hemoperitoneum
0:59
and confirms the findings at the FAST exam.
1:03
As we scroll into the pelvis, we see
1:05
a significant amount of hemoperitoneum
1:07
layering along the right greater
1:09
than left pericolic gutters as well.
1:14
As we enter the pelvis, we see
1:16
clotted blood products which are
1:18
intermixed with the adjacent bowel.
1:21
The uterus is best visualized on the
1:24
venous phase images, and we can see a normal
1:26
appearing uterus which is minimally enlarged,
1:30
with a normal appearing endometrial cavity.
1:34
In the right adnexa, there is a
1:37
markedly peripherally enhancing
1:39
structure with central hypoattenuation.
1:43
And what's important to note
1:44
about this structure is the
1:45
degree of peripheral vascularity.
1:48
We can also see a significant
1:49
amount of recruited vasculature
1:51
extending toward this structure.
1:55
On the venous phase images adjacent to this
1:57
structure, we can visualize the normal right
2:00
ovary, which has a corpus luteum within it.
2:04
The left ovary is also
2:05
visualized in the left adnexa.
2:07
So we have an extra-ovarian peripherally
2:10
enhancing structure in the right adnexa
2:12
with a significant amount of pelvic
2:14
hemoperitoneum, with hemoperitoneum
2:17
extending into the upper abdominal quadrants.
2:20
Given the clinical history and the appearance
2:22
of the imaging findings, concern was
2:24
raised for a ruptured ectopic pregnancy.
2:27
The patient was taken to the OR,
2:28
which confirmed the diagnosis.
Report
Faculty
Erin Gomez, MD
Assistant Professor of Radiology
Johns Hopkins Hospital
Tags
Women's Health
Uterus
Ovaries
Gynecologic (Gyn)
Gynecologic (GYN)
Genitourinary (GU)
Fallopian Tubes
CT
Body
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