Case of the Week: Ruptured Ectopic Pregnancy (Ultrasound)

In this radiology lecture, we discuss the ultrasound appearance of ruptured ectopic pregnancy.
Key points include:
1) Most ectopic pregnancies occur in the fallopian tube: Ampulla most common, followed by isthmus and fimbria.
2) Risk factors: Prior ectopic pregnancy, prior surgery (fallopian tube), pelvic inflammatory disease, endometriosis, IVF.
3) “A single measurement of hCG, regardless of its level, does not reliably distinguish between ectopic and intrauterine pregnancy (viable or nonviable).”*
4) Levels of hCG in ectopic pregnancies are highly variable.
5) Tubal rupture main complication, occurs in up to 20%.
6) Free fluid in pelvis alone nonspecific, but echogenic fluid in Morison pouch (subhepatic space) and cul-de-sac raises concern for rupture.
7) Rupture is a relative contraindication to methotrexate (medical) therapy.
*Doubilet PM, Benson CB, Bourne T, et al. Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med 2013;369:1443-51.
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[@skeletopedia3122]

Ectopics are sometimes very challenging for a radiologist to identify--really appreciate your overview!! I get nervous with tough Gyn US cases, and would love to see more content in this area. Thanks again.

[@Radquarters]

Glad you liked it! I agree, ectopics can be difficult. I'll continue with the GYN cases!

[@nutellapringles]

Qualified work, as usual. Thanks Dr. Kowal.

[@Radquarters]

So nice of you, and thanks for watching!

[@khankickkhan2541]

your description is awesome

[@Radquarters]

Thanks so much!

[@Gragon]

your vids are greatly appreciated.

[@Radquarters]

Glad you like them!

[@azharsyed1867]

Thanks

[@Radquarters]

You're welcome!

[@stephdaigle2900]

This just just happened to me just last week! Thankfully my blood tests were taken right before I went for ultrasound which showed I was pregnant, but apparently when they got back they didn’t see any fetus in the uterus .. sadly required my Fallopian tube to get cut out

[@merimuskan1]

Same thing happened with me 1 & half months ago

[@rajasreebanerjee1727]

commentary a bit toooo fast

[@Radquarters]

Thank you for the feedback. If you click settings (gear icon) on the lower right of the screen, you can adjust the playback speed.