Interactive Transcript
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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.
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