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Interstitial ectopic pregnancy

Case contributed by Matthew Lukies
Diagnosis almost certain

Presentation

Spotting blood per vagina for 3 weeks, followed by 2 days of heavy vaginal bleeding. Crampy lower abdominal pain and diarrhea.

Patient Data

Age: 40 years
Gender: Female
ultrasound
  • anteverted uterus of normal, non-pregnant size

  • no gestational sac within the endometrial cavity

  • right-sided corpus luteum

  • ~2 cm rounded hyperechoic focus with a thin line of communication back to the endometrium

    • there is a very thin amount of myometrium overlying the hyperechoic focus

  • the left ovary is unremarkable

  • no free fluid is seen in the pelvis

Case Discussion

This case is a typical demonstration of an interstitial ectopic pregnancy, with a thin surrounding myometrial layer (myometrial mantle) and a hyperechoic line from the mass to the endometrium (interstitial line sign).

The patient in this case was not on the oral contraceptive pill and had a bHCG of 1300. She was treated with IM methotrexate and a serial bHCG follow-up.

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