Radiology.Academy.Sk

Neuro Review
Appendix
Spleen
Stomach
Kidneys
Kidney
Pancreas
Pelvic congestion syndrome
Liver
Biliary
CT Abd Epiploic Appendagitis
Fractures Wrist
Wrist
Diffuse periosteal reaction
Signs in Uroradiology
Male breast
MRI Breast Indications
CT Head Cerebellar Mass
Biopsies
Diagnostic mammography
Screening mammography
Mammo Pearls
ACR Appropriateness Criteria Breast Cancer Screen
AVM types
CT Orbits
CT Abd NL
Chiari Malformations
Vesicoureteral Reflux (VUR)
Elbow
XRAY Abdominal Series

Abdomen
Cardio
Chest
Dictation Templates
General
GU
Mammography
MSK
neuro
Neuroradiology
NM
Nuclear Medicine
Pediatric
Physics
Ultrasound
Upload

Ectopic Pregnancy

1st trimester pregnancy with irregular bleeding, abdominal or pelvic pain, tender adnexal mass; hCG doubles every 2 days in normal pregnancy


DDx of positive pregnancy test

  • Normal Intrauterine Pregnancy (IUP)
  • Abnormal IUP: spontaneous abortion, hydatid mole
  • Ectopic Pregnancy

When pregnancy test is positive, the ONLY finding that rules out ectopic pregnancy is the detection of an IUP.

When pregnancy test is positive and there is no evidence of an IUP, ANY adnexal finding other than intra-ovarian cyst should be considered an ectopic pregnancy until proven otherwise.

Location of Ectopic pregnancy

  • Fallopian tubes (ampullary or isthmic): 95-97%
  • Uterine cornua < 5%
  • Ovary < 1%
  • Broad ligament and intraperitoneally < 0.03%
  • Cervix < 0.1%
  • Heterotopic pregnancy: concomitant IUP and ectopic - 1:7000

Pseudogestational sac

Collection of fluid or echogenic material (decidual cast) within the endometrium (IUP fake out), 5% of ectopics

Decidual cysts

In the periphery of hyperechoic endometrium; associated with ectopic pregnancy

Interstitial (cornual) pregnancy

Eccentrically positioned within the most lateral portion of the uterine fundus; Interstitial line sign: Hyperechoic endometrial line abuts on the midportion of the sac rather than going around it

Adnexal Ectopic Pregnancy

  • Extrauterine embryo with positive Heart Beat: 100% sensitive (25% studies)
  • Adnexal mass containing Yolk Sac or non-living embryo: 100% sensitive
  • Tubal ring surrounding a fluid collection: 95%, has to be separated from the ovary (to make sure it is not corpus luteal cyst), Gestational Sac surrounded by a trophoblast
  • Complex or solid adnexal mass (no Embryo, no YS, no tubal ring): 92%. An adnexal mass can be complex or solid and of any shape from round to ovoid to irregular. If ruptured - very irregular. Intraperitoneal fluid with internal echoes = hemorrhage.