Document Detail


Atypical presentation of a large interstitial pregnancy.
MedLine Citation:
PMID:  23250569     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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.
Authors:
Matthew Rheinboldt; Sherif Ibrahim
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-19
Journal Detail:
Title:  Emergency radiology     Volume:  -     ISSN:  1438-1435     ISO Abbreviation:  Emerg Radiol     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9431227     Medline TA:  Emerg Radiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Emergency Radiology, Henry Ford Hospital, Detroit, MI, USA, mrheinbold@yahoo.com.
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