1) Recognize the spectrum of findings at transvaginal ultrasound in ectopic pregnancy. 2) Report TVUS findings in suspected ectopic pregnancy when a non-specific intrauterine fluid collection is present. 3) Differentiate usual vs. “unusual” ectopic pregnancies and understand their different treatment algorithms. 4) Understand the limitations of ultrasound related to maternal and technical factors. 5) Assist clinicians with appropriate follow up/management recommendations in excluding and diagnosing ectopic pregnancy.
Transvaginal ultrasound is the primary imaging modality to evaluate suspected ectopic pregnancy, performed in patients with a positive pregnancy test and pain or bleeding. The diagnosis is most commonly made when ultrasound demonstrates no intrauterine gestational sac and an extraovarian adnexal mass is found. Ectopic pregnancies occur in the ampulla of the fallopian tube >90% of the time and therapy is well established including systemic methotrexate and/or salpingectomy. When attempting to exclude or diagnose ectopic pregnancy, TVUS may demonstrate a non-specific intrauterine fluid collection. The term “pseudogestational sac” should not be used to describe an intrauterine fluid collection as this term can be confusing and improperly imply ectopic pregnancy prompting premature treatment. Rather, any intrauterine fluid collection should be regarded as a potential intrauterine pregnancy and reported as such. Ectopic pregnancies may also occur in “unusual” locations such as: the cervix, a cesarean section scar, the interstitial portion of the fallopian tube, within the ovary or concomitant with an intrauterine pregnancy. These “unusual” ectopic pregnancies are a unique subset of ectopic pregnancies requiring prompt diagnosis and alternative treatment options. Ultrasound does carry with it some limitations in the diagnosis of ectopic pregnancy related to both maternal and technical factors. Prompt diagnosis of all types of ectopic pregnancy and recognizing potential early intrauterine pregnancies will allow for appropriate follow up, optimal treatment and improve outcomes for these patients.
<a href="http://media.rsna.org/media/abstract/2013/13010307/RC210B PetersSECURED.pdf" target="_blank">http://media.rsna.org/media/abstract/2013/13010307/RC210B PetersSECURED.pdf</a>
Peters, H,
Diagnosis and Treatment of Ectopic Pregnancy. Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL.
http://archive.rsna.org/2013/13010307.html
