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Ruptured Tubal Ectopic US

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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

0:39

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.

Report

Faculty

Erin Gomez, MD

Assistant Professor of Radiology

Johns Hopkins Hospital

Tags

Women's Health

Uterus

Ultrasound

Ovaries

Gynecologic (Gyn)

Gynecologic (GYN)

Genitourinary (GU)

Fallopian Tubes

Body

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