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This is an ultrasound of the pelvis performed

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in a patient presenting with exquisite right

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pelvic pain and an abnormal beta HCG in the

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context of a positive home pregnancy test.

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We begin with transabdominal

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images of the pelvis where the

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sonographer has measured the uterus.

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We can see the hyperechoic endometrial stripe

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without a discrete intrauterine gestational sac.

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Again, we have a coronal image of the uterus

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where we can see the hyperechoic endometrium

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and no apparent gestational sac visible.

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In this patient with suspected ectopic

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pregnancy, the sonographer has also obtained

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images of the upper abdominal quadrants,

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again to determine whether there is a

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significant amount of intraperitoneal free fluid.

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In this patient, we see a clear delineation

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between the liver and kidney with intervening

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fat and without significant free fluid present.

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These are transvaginal images of the pelvis.

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Again, we see the uterus.

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With myometrium and echogenic endometrium, we

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do not see an intrauterine gestational sac.

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Lateral to the uterus in the right

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adnexa, we see a peripherally hyperechoic

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structure with central hypoechogenicity

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and a well-circumscribed cystic structure.

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A fetal pole is identified within this

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structure in the right adnexa with a crown

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rump length corresponding to an estimated

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gestational age of 7 weeks and 1 day.

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The yolk sac is also present within

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this extrauterine gestational sac.

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M-mode evaluation of the fetal pole demonstrates

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positive embryonic cardiac activity with

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a heart rate of 124 beats per minute.

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The right ovary is identified and is separate

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from the previously described adnexal lesion.

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The left ovary is also identified

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and is normal in appearance.

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To summarize, we see a well-circumscribed,

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hyperechoic structure that is separate

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from the ovary in the right adnexa,

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with internal hypoechogenicity and a visible

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fetal pole with positive cardiac activity.

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This is a viable ectopic pregnancy

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within the right fallopian tube.