Interactive Transcript
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This is an ultrasound of the pelvis
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in a patient with a positive home
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pregnancy test presenting with left lower
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quadrant abdominal pain and tachycardia.
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We have transabdominal images of the pelvis
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and a long view or sagittal view of the uterus.
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As we evaluate the endometrial cavity, we see
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the hyperechoic endometrial stripe without
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a visible intrauterine gestational sac.
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Additional transverse plane images of the
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uterus again demonstrate normal myometrium
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and a hyperechoic endometrial stripe.
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Endometrium without a gestational sac visible.
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The right ovary is identified on transabdominal
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imaging and is normal in size and appearance.
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In the left adnexa, posterior and lateral
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to the uterus, which is located here,
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there is a heterogeneously hyperechoic
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and hypoechoic mass measuring at least 6.1 centimeters.
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21 00:00:56,680 --> 00:00:58,099 Within the mass, we can see a
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discrete hyperechoic ring-like
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structure with central heterogeneity.
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Evaluation of the upper abdominal
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quadrants demonstrates significant free
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fluid adjacent to the right kidney.
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Transvaginal images of the pelvis at the level
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of the uterus and cervix also demonstrate
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significant free fluid in the cul-de-sac.
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It can be noted that the endometrium is
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thickened without a gestational sac present.
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Transvaginal ultrasound images of the
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heterogeneous left adnexal mass again
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demonstrate heterogeneously hypoechoic tissue.
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With a peripherally hyperechoic
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structure with central hypoechogenicity.
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Lace-like echoes and free fluid are seen
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adjacent to the mass in the left adnexa,
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suggestive of clotted blood products.
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On these color Doppler transvaginal images
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of the left adnexa, we again see the lesion,
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which is a ring-like hyperechoic structure
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with intense peripheral vascularity.
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This is known as the ring of fire sign.
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This is an additional transvaginal
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ultrasound image of the left adnexa, where
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we see a ring-like hypoechoic structure
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with central hypoechoic components.
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Lastly, these are transverse transvaginal
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images of the uterus from inferior to superior.
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We can see that surrounding the uterus
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there's a significant amount of free fluid.
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I want to point out the
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appearance of the fluid here.
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This is not just simple fluid, right?
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Simple fluid in the pelvis looks
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anechoic and would be darker than this.
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Anytime you see free fluid in the pelvis
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that looks like it's a handful of sand that's
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been dumped into a jar of water and shaken up.
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This grainy, slightly hyperechoic
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appearance, these are blood products.
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So this patient has a significant
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amount of pelvic hemoperitoneum.
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To summarize, we have a ring-like,
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hypervascular structure in the left adnexa
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with adjacent clotted blood products and
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significant abdominal pelvic hemoperitoneum.
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This patient was taken to surgery and
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a diagnosis of ruptured left tubal
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ectopic pregnancy was confirmed.
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