Abstract
We report the case of a 20-year-old female who presented to the ER with a 1-week history of worsening abdominal pain and intermittent vaginal bleeding for the previous 5 days. Physical exam was notable for bilateral adnexal tenderness and a closed cervix without motion tenderness or discharge. Laboratory data demonstrated a beta HCG level of 7,787 IU/L, and pelvic ultrasound with transvaginal imaging was subsequently performed. Neither an adnexal mass nor a normal intrauterine pregnancy was demonstrable; however, a focal right fundal 7-cm area of heterogeneous echogenicity was observed. Initial findings were felt indeterminate with considerations including potential degenerating leiomyoma coexistent with a nonvisualized intrauterine pregnancy, ectopic pregnancy, or recent spontaneous abortion versus atypical interstitial ectopic pregnancy. The patient, initially declining further clinical intervention, returned within 24 h with continued pain. A repeat ultrasound demonstrated a relatively static and unchanged appearance with only a minimal concurrent interval increase in beta HCG levels. MRI was performed for further elucidation and demonstrated a heterogeneously hypervascular right fundal interstitial 6-cm mass, which, in the clinical context, was most suspicious for an ectopic pregnancy. Confirmatory laparoscopic cornual wedge resection and salpingectomy was subsequently performed.
Similar content being viewed by others
References
Moawad N, Mahajan S, Moniz M, Taylor S, Hurd W (2010) Current diagnosis and treatment of interstitial pregnancy. AJOG 202(1):15–19
Lau S, Tulandi T (1999) Conservative medical and surgical management of interstitial ectopic pregnancy. Fertil Steril 72:207–215
Ackerman TE, Levi CS, Dashefsky S, Holt S, Lindsay D (1993) Interstitial line: sonographic finding in interstitial (cornual) ectopic pregnancy. Radiology 189:83–87
Timor-Tritsch I, Monteagudo A, Matera C, Veit C (1992) Sonographic evolution of cornual pregnancies treated without surgery. Obstet Gynecol 79:1044–1049
Walker J (2007) Ectopic pregnancy. Clin Obstet Gynecol 50:89–99
Tulandi T, Al-Jaroudi D (2004) Interstitial pregnancy: results generated from the Society of Reproductive Surgeons Registry. Obstet Gynecol 103:47–50
Bickell N, Bodian C, Anderson R, Kase N (2004) Time and the risk of ruptured tubal pregnancy. Obstet Gynecol 104:789–794
Soriano D, Vicus D, Mashiach R, Schiff E, Seidman D, Goldberg M (2008) Laparoscopic treatment of cornual pregnancy: a series of twenty consecutive cases. Fertil Steril 90:839–843
Bourdel N, Roman H, Gallot D (2007) Interstitial pregnancy. Ultrasonographic diagnosis and contribution of MRI: a case report. Gynecol Obstet Fertil 35:121–124
Jermy K, Thomas J, Doo A, Bourne T (2004) The conservative management of interstitial pregnancy. BJOG 111:1283–1288
Chan L, Yuen P (2003) Successful treatment of ruptured interstitial pregnancy with laparoscopic surgery: a report of 2 cases. J Reprod Med 48:569–571
Sagiv R, Golan A, Arbel-Alon S, Glezerman M (2001) Three conservative approaches to treatment of interstitial pregnancy. J Am Assoc Gynecol Laparosc 8:154–158
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rheinboldt, M., Ibrahim, S. Atypical presentation of a large interstitial pregnancy. Emerg Radiol 20, 251–254 (2013). https://doi.org/10.1007/s10140-012-1096-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10140-012-1096-2