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Cornual pregnancy

Presentation: The patient, a 35 year old lady having history of 3 vaginal deliveries (P 3) is a known case of severe mitral stenosis. She presented with abdominal pain which is more intense in lower abdomen since last one month. She is not using any contraceptive and has no history of amenorrhea.

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Caption: Uterus, sagital section
Description: No gestational sac is seen inside the cavity

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Caption: Transverse section of the uterus
Description: A thick walled cystic mass is seen in the right cornual area.

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Caption: The mass at different planes
Description: An echogenic mass is seen inside the cyst.

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Caption: Fluid filled mass at a different level    
Description: The echogenic mass inside the sac is an embryo without cardiac activity. CRL corresponds to 7wk 4 day.

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Caption: The uterus with the mass
Description: The mass is seen enlarging the right cornual area.

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Caption: The cornual mass
Description: Right tube arising from the mass

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Caption: Cut section of the uterus.
Description: Gestational sac and the uterine cavity are seen separately.

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Caption: The sac and the embryo
Description: The cornual pregnancy confirmed.

Discussion: On endovaginal scanning, the endometrial cavity appeared normal with endometrial thickness of 10mm. There is a thick walled cystic structure with a small floating lightly echogenic mass inside. The mass is seen in right of the fundus separate from the endometrial cavity. It appeared either a intramural fibroid with cystic degeneration or a cornual pregnancy with a dead embryo inside it. The positive gravindex test of the urine clinched the diagnosis in favour of the later.

Final: Cornual Pregnancy

Follow up: The patient opted for hysterectomy instead of removal of the mass. Our diagnosis was proved at the laparotomy.