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Acute pelvic pain in female with ruptured ectopic pregnancy: Magnetic Resonance Imaging as problem solving tool

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The ultrasound performed by the referring physician showed a complex right adnexal lesion abutting the uterus with no free fluid in the pelvis, prompting the physician to think of a broad ligament fibroid... As the physician felt that ultrasound was not contributing to a proper diagnosis, MRI pelvis was requested to help solve the clinical problem... MRI of the pelvis revealed a tubular structure with T2 hypointense fluid level measuring ∼4.1 × 2.3 × 4.1 cm in the right adnexal region, medial to the right ovary (Fig.  1)... Though ultrasound is the primary modality for diagnosing ectopic pregnancy, MRI of the pelvis has a definite role as a problem solving tool... Though more than 90% of ectopic pregnancies are visualized on transvaginal ultrasound, false positive diagnoses account for about 5–6%... Corpus luteum, bowel, paratubal cyst, hydrosalpinx, endometrioma and fibroid account for the false positive diagnoses of ectopic pregnancy... The classic findings of ectopic pregnancy on MRI are lack of intrauterine pregnancy, hemoperitoneum, tubal mass, hematosalpinx and wall enhancement of the dilated fallopian tube., The presence of hematosalpinx in a woman with a positive pregnancy test and with no intrauterine gestational sac is highly concerning for ectopic pregnancy, even in the absence of a clearly identifiable extra-uterine gestational sac... The inclusion of a T1-weighted pulse sequence is helpful in identifying blood products and is recommended as part of imaging protocol for pregnant patients... Mimics of ectopic pregnancy include corpus luteal cyst and ovarian masses... Differentials for hemoperitoneum include placentation abnormalities like placenta accreta and percreta... It is imperative that the radiologists, obstetricians and emergency physicians be familiar with these features and always consider the possibility of ectopic pregnancy in the setting of hemoperitoneum or a pelvic mass in a woman of child-bearing age.

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Axial T2-weighted image demonstrates a hypointense fluid level in the tubular structure, representing hemorrhage in the right fallopian tube (black arrow).
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fig1: Axial T2-weighted image demonstrates a hypointense fluid level in the tubular structure, representing hemorrhage in the right fallopian tube (black arrow).

Mentions: A 31 year old female was referred to our Magnetic Resonance Imaging (MRI) department with history of lower abdominal pain for three days. The patient had a history of irregular periods, with no definite period of amenorrhea. There was no history of bleeding per vagina. The ultrasound performed by the referring physician showed a complex right adnexal lesion abutting the uterus with no free fluid in the pelvis, prompting the physician to think of a broad ligament fibroid. Subsequently the patient tested mildly positive for urine gravindex. As the physician felt that ultrasound was not contributing to a proper diagnosis, MRI pelvis was requested to help solve the clinical problem. Blood sample was given for assessment of Serum human chorionic gonadotropin (beta hCG) level at this same time. MRI images are shown as Fig. 1, Fig. 2, Fig. 3, Fig. 4.


Acute pelvic pain in female with ruptured ectopic pregnancy: Magnetic Resonance Imaging as problem solving tool
Axial T2-weighted image demonstrates a hypointense fluid level in the tubular structure, representing hemorrhage in the right fallopian tube (black arrow).
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5121271&req=5

fig1: Axial T2-weighted image demonstrates a hypointense fluid level in the tubular structure, representing hemorrhage in the right fallopian tube (black arrow).
Mentions: A 31 year old female was referred to our Magnetic Resonance Imaging (MRI) department with history of lower abdominal pain for three days. The patient had a history of irregular periods, with no definite period of amenorrhea. There was no history of bleeding per vagina. The ultrasound performed by the referring physician showed a complex right adnexal lesion abutting the uterus with no free fluid in the pelvis, prompting the physician to think of a broad ligament fibroid. Subsequently the patient tested mildly positive for urine gravindex. As the physician felt that ultrasound was not contributing to a proper diagnosis, MRI pelvis was requested to help solve the clinical problem. Blood sample was given for assessment of Serum human chorionic gonadotropin (beta hCG) level at this same time. MRI images are shown as Fig. 1, Fig. 2, Fig. 3, Fig. 4.

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

The ultrasound performed by the referring physician showed a complex right adnexal lesion abutting the uterus with no free fluid in the pelvis, prompting the physician to think of a broad ligament fibroid... As the physician felt that ultrasound was not contributing to a proper diagnosis, MRI pelvis was requested to help solve the clinical problem... MRI of the pelvis revealed a tubular structure with T2 hypointense fluid level measuring ∼4.1 × 2.3 × 4.1 cm in the right adnexal region, medial to the right ovary (Fig.  1)... Though ultrasound is the primary modality for diagnosing ectopic pregnancy, MRI of the pelvis has a definite role as a problem solving tool... Though more than 90% of ectopic pregnancies are visualized on transvaginal ultrasound, false positive diagnoses account for about 5–6%... Corpus luteum, bowel, paratubal cyst, hydrosalpinx, endometrioma and fibroid account for the false positive diagnoses of ectopic pregnancy... The classic findings of ectopic pregnancy on MRI are lack of intrauterine pregnancy, hemoperitoneum, tubal mass, hematosalpinx and wall enhancement of the dilated fallopian tube., The presence of hematosalpinx in a woman with a positive pregnancy test and with no intrauterine gestational sac is highly concerning for ectopic pregnancy, even in the absence of a clearly identifiable extra-uterine gestational sac... The inclusion of a T1-weighted pulse sequence is helpful in identifying blood products and is recommended as part of imaging protocol for pregnant patients... Mimics of ectopic pregnancy include corpus luteal cyst and ovarian masses... Differentials for hemoperitoneum include placentation abnormalities like placenta accreta and percreta... It is imperative that the radiologists, obstetricians and emergency physicians be familiar with these features and always consider the possibility of ectopic pregnancy in the setting of hemoperitoneum or a pelvic mass in a woman of child-bearing age.

No MeSH data available.


Related in: MedlinePlus