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Tubal
Rupture ectopic pregnancy

Tubal rupture ectopic pregnancy ultrasound case study

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Tubal rupture ectopic pregnancyultrasound case study

CASE–1

Clinical History

A reproductive-age female presented with acute lower abdominal pain, amenorrhea, vaginal spotting, dizziness, and a positive urine/serum β-hCG. Clinical suspicion of ruptured left ovarian ectopic pregnancy. Ultrasound was performed for evaluation of the uterus, adnexa, and hemoperitoneum.

Ultrasound Findings

Ultrasound examination demonstrates an empty uterine cavity with no evidence of an intrauterine gestational sac. A heterogeneous complex left adnexal/ovarian mass containing mixed echogenic and cystic components is identified adjacent to and inseparable from the left ovary, consistent with a ruptured ectopic gestation. Peripheral hypervascularity ("ring of fire" sign) is demonstrated on color Doppler. Moderate to large volume complex free fluid with internal echoes is present within the pelvis, pouch of Douglas, bilateral adnexa, and extending into the paracolic gutters, consistent with hemoperitoneum. The right ovary appears unremarkable. No definite intrauterine pregnancy is identified.

Pelvic ultrasound. A complex hypervascular left ovarian/adnexal mass with surrounding hemoperitoneum is demonstrated. The findings are consistent with a ruptured left tubal ectopic pregnancy.

Report Line

An empty uterine cavity is demonstrated without evidence of an intrauterine gestational sac. A heterogeneous hypervascular complex left ovarian/adnexal mass is identified (71 x 35 mm), inseparable from the left ovary, with associated moderate to large complex free intraperitoneal fluid consistent with hemoperitoneum. Sonographic findings are diagnostic of a ruptured left ovarian ectopic pregnancy.

Impression

Features are consistent with a ruptured left ovarian / adnexal ectopic pregnancy.

Recommendation

Immediate obstetric/gynecological consultation and emergency surgical management are recommended. Correlation with quantitative serum β-hCG, complete blood count, and hemodynamic status is essential. Urgent laparoscopic or open surgical exploration should be considered depending on the patient's clinical condition. Blood grouping and cross-matching should be performed in anticipation of possible transfusion.

Key Learning Points

An empty uterus with a positive β-hCG should raise suspicion for ectopic pregnancy until proven otherwise.
Ovarian ectopic pregnancy is rare and appears as a complex hypervascular adnexal/ovarian mass on ultrasound.
The peripheral "ring of fire" vascularity on color Doppler supports the diagnosis but is not specific.
Complex free fluid with internal echoes is highly suggestive of hemoperitoneum due to rupture.
Ruptured ectopic pregnancy is a life-threatening emergency requiring prompt surgical management.
Transvaginal ultrasound is more sensitive than transabdominal ultrasound for early diagnosis.
Clinical correlation with serum β-hCG levels and hemodynamic assessment is essential for appropriate management.