Presentation
The patient came to the emergency department with right lower quadrant abdominal tenderness and sporadic vaginal bleeding for seven days. The patient did not have fever, nausea, or vomiting. Qualitative and quantitative beta HCG tests were run at the emergency department and came back positive.
Patient Data
No evidence of intrauterine gestational sac. Tubal ring like structure is present in the right adnexa adjacent and probably separate from the right ovary, which could represent tubal ectopic pregnancy. Nonspecific heterogeneous thickened and echogenic contents within the endometrial canal, may represent blood products. A complex cyst is present in the right ovary, with increased peripheral vascularity, likely represent corpus luteal cyst.
Case Discussion
During an emergency room visit the patient's fetus gestational age was determined by the last menstrual period date and was 7 weeks and 2 days. Quantitative beta HCG level was also obtained which corresponded to estimated gestational age of 3 weeks. Findings such as right adnexa tubal ring structure with increased vascularity peripherally (ring of fire appearance) adjacent and separate from the ovary with no evidence of intrauterine gestational sac along with positive beta HCG most likely represent tubal ectopic pregnancy.
The case was reviewed and discussed with Dr. Morlie L. Wang MD, MPH, Program Director of Diagnostic Radiology who stood in agreement with the findings.
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