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Obstetrics » Obstetrics 1st Trimester
Heterotropic pregnancy -intrauterine and left tubal ectopic
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Presentation A 25 year old woman presents with eight weeks amenorrhea and acute onset of pain in the lower abdomen.
 
 
 
Caption: Sagittal image of the uterus.
Description: A normal-appearing intrauterine pregnancy is noted.
 
 
 
Caption: Transverse image of the left adnexa.
Description: A large amount of echogenic free fluid is noted in the pelvis, suggestive of hemoperitoneum.
 
 
 
Caption: Transverse image of the left adnexa.
Description: Surrounding the ectopic gestational sac is a complex collection of echogenic fluid that appears loculated. This mostly likely represents clotted blood.
 
 
 
Caption: Transverse image of the left adnexa.
Description: Both the intrauterine gestational sac [eutopic pregnancy] and the gestational sac in the left adnexa [ectopic pregnancy] are noted side by side in this image.
 
 
 
Caption: Transverse image of the left adnexa.
Description: A second gestational sac with a distinctive echogenic rim or ring is noted in the left adnexa. Echogenic free fluid is seen in the pelvis.
 
Differential Diagnosis Heterotopic pregnancy.
 
Final Diagnosis Heterotopic pregnancy – concurrent intrauterine pregnancy and left adnexal ectopic pregnancy.
 
Follow Up At surgery, a dilated left tube with a gestational sac in the ampullary region was found. A left salpingectomy was performed. The intrauterine pregnancy was continued to term, resulting in a normal healthy child.
 
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