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Ruptured Tubal Ectopic CT

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This is a CTA of the abdomen and

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pelvis in a patient presenting with

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acute onset right-sided pelvic pain.

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When she came to the emergency department,

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her blood pressure was lower than expected

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for a patient of her age, and so they

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performed a FAST exam, which is an ultrasound

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survey of the abdominal quadrants.

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The FAST exam was positive for hemoperitoneum,

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and so despite a pending beta-HCG,

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the patient was sent for CTA of the abdomen and

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pelvis to further evaluate a source of bleeding.

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Arterial phase CT images are on the left

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side of the screen, and venous phase CT

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images are on the right side of the screen.

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Immediately as we enter the upper

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abdominal quadrants, we can see a

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significant amount of low-density free

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fluid surrounding the liver and spleen.

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If we draw a region of interest on this fluid,

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we can see that the internal attenuation is 37

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HU units, which is indicative of hemoperitoneum

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and confirms the findings at the FAST exam.

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As we scroll into the pelvis, we see

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a significant amount of hemoperitoneum

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layering along the right greater

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than left pericolic gutters as well.

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As we enter the pelvis, we see

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clotted blood products which are

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intermixed with the adjacent bowel.

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The uterus is best visualized on the

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venous phase images, and we can see a normal

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appearing uterus which is minimally enlarged,

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with a normal appearing endometrial cavity.

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In the right adnexa, there is a

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markedly peripherally enhancing

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structure with central hypoattenuation.

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And what's important to note

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about this structure is the

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degree of peripheral vascularity.

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We can also see a significant

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amount of recruited vasculature

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extending toward this structure.

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On the venous phase images adjacent to this

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structure, we can visualize the normal right

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ovary, which has a corpus luteum within it.

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The left ovary is also

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visualized in the left adnexa.

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So we have an extra-ovarian peripherally

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enhancing structure in the right adnexa

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with a significant amount of pelvic

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hemoperitoneum, with hemoperitoneum

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extending into the upper abdominal quadrants.

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Given the clinical history and the appearance

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of the imaging findings, concern was

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raised for a ruptured ectopic pregnancy.

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The patient was taken to the OR,

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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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