Case of the Week: Ruptured Ectopic Pregnancy (Ultrasound)

In this radiology lecture, we discuss the ultrasound appearance of ruptured ectopic pregnancy.

Key points include:
1) Most ectopic pregnancies occur in the fallopian tube: Ampulla most common, followed by isthmus and fimbria.
2) Risk factors: Prior ectopic pregnancy, prior surgery (fallopian tube), pelvic inflammatory disease, endometriosis, IVF.
3) “A single measurement of hCG, regardless of its level, does not reliably distinguish between ectopic and intrauterine pregnancy (viable or nonviable).”*
4) Levels of hCG in ectopic pregnancies are highly variable.
5) Tubal rupture main complication, occurs in up to 20%.
6) Free fluid in pelvis alone nonspecific, but echogenic fluid in Morison pouch (subhepatic space) and cul-de-sac raises concern for rupture.
7) Rupture is a relative contraindication to methotrexate (medical) therapy.

*Doubilet PM, Benson CB, Bourne T, et al. Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med 2013;369:1443-51.

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