Presentation1.pptx, radiological imaging of ectopic pregancy.

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Presentation1.pptx, radiological imaging of ectopic pregancy.

  1. 1. Radiological imaging of ectopic pregnancy. Dr/ ABD ALLAH NAZEER. MD.
  2. 2. Ectopic pregnancy is a major health problem for women of childbearing age and a leading cause of pregnancy- related death in the first trimester. Untreated, ectopic pregnancy can lead to massive hemorrhage, infertility and death. With the advent of high-resolution transvaginal sonography, in conjunction with serum assays for the ß- subunit of human chorionic gonadotropin (ß-hCG), rapid and accurate diagnosis of this entity is now routinely possible. Ectopic pregnancy is defined as implantation of a fertilized ovum outside the endometrial lining of the uterus. Based on data from the Centers for Disease Control and Prevention, ectopic pregnancy has an incidence of approximately 2% of all reported pregnancies and accounts for 9% of pregnancy related deaths.
  3. 3. Locations of ectopic pregnancy. (A) ampullary/isthmic, (B) infundibulum, (C) fimbria, (D) interstitial, (E) intra-abdominal, (F) ovarian and (G) cervical.
  4. 4. Etiology of ectopic pregnancy. Congenital. Tubal hypoplasia, Tubal turtuosity, Congenital diverticulae, Accessory ostia, Partial stenosis, Elongation, Intra-mural polyp and Entrap the ovum on its way. Acquired. Pelvic inflammatory disease. Chlamydia trachomatis is most common. Contraceptive failure. Smoking. Multiple sexual partners. Endometriosis. History of tubal surgery. Endometriosis and leiomyoma. Recent use of in vitro fertilization.
  5. 5. Magnetic Resonance Imaging. MRI findings that can suggest an ectopic pregnancy include the presence of a tubal gestational sac; a tubal hematoma, which is a hematoma suggested by the ring sign (peripheral hyperintensity) on T1- weighted images; tubal wall enhancement; and an adnexal mass with hemorrhagic fluid in the peritoneum. Blood is suggested by the presence of high-signal-intensity fluid on T1-weighted images. The MRI characteristics of an ectopic pregnancy and its rupture are seen in the T2-weighted images.
  6. 6. Live cervical ectopic pregnancy at 6 weeks gestational age. Sagittal view of the cervix shows the gestational sac with an embryo (arrow) within the cervix.
  7. 7. Heterotopic pregnancy in an in vitro fertilization patient at 15 weeks gestational age. (a) Transabdominal view shows no myometrium (arrows) around the ovarian ectopic pregnancy. (b) Coronal T2-weighted magnetic resonance (MR) image IUP and ectopic pregnancy (EP). P = placenta. MR was used for surgical planning to show the blood flow to the heterotopic pregnancy. Note the flow void in vessels (arrows) supplying the ovarian ectopic pregnancy. After surgical removal of the ectopic pregnancy, the IUP continued to term.
  8. 8. Tubal ring of ectopic pregnancy. (a) Transvaginal transverse view of the left adnexa shows an echogenic ringlike mass (arrows) medial to the left ovary. Within the left ovary is a thick-walled corpus luteum cyst (arrowheads). Note that the wall of the ectopic pregnancy is more echogenic than the wall of the corpus luteum cyst. (b) Color Doppler image shows more blood flow (arrowheads) to the corpus luteum than to the ectopic pregnancy (arrow). Note that the “ring of fire” (hypervascular ring) appearance in the adnexa can be seen with both ectopic pregnancy and corpus luteum.
  9. 9. Interstitial ectopic pregnancy 8 weeks after LMP. Sagittal transvaginal view of the uterus (UT) demonstrates a thick-walled mass arising from the interstitial portion of the uterus. The embryo is measured with calipers.
  10. 10. Ectopic pregnancy. Abdominal/pelvic CT. Image compatible with gestational sac in the left adnexal region (arrow on A), separated from the uterine image (stars on A and B) and from the ipsilateral ovary identified by visualization of the corpus luteum (hollow arrow on B). Also, note the presence moderate amount of fluid in the peritoneal cavity with foci of high density characterizing hematic content (L). (A,B: contrast-enhanced axial sections in the portal phase).
  11. 11. Axial T2-weighted fast spin-echo magnetic resonance image of the pelvis. This image shows an abnormal fluid-containing fallopian tube (red arrow) on the right side. A simple right ovarian cyst (white arrow) is also present.
  12. 12. Ectopic pregnancy. Pelvic MRI. The presence of a gestational sac is observed in the left adnexal region (arrows on A and B), in association with a heterogeneous mass (arrow on C). Note the uterine and ovarian images (stars on A and D) separated from the adnexal mass, as well as the presence of placenta showing contrast enhancement (hollow arrow on D). (A: axial T2-weighted; B: coronal T2-weighted; C: sagittal T2- weighted; D: post-contrast axial T1-weighted images).
  13. 13. Ectopic pregnancy. Pelvic MRI. Expansile, heterogeneous mass in the right adnexal region (arrows on A to D), separated from the uterine (star on B) and ovarian (hollow arrows on A and B) images. Also, note the presence of moderate amount of free fluid in the pelvis, with intermediate signal intensity on T1-weighted images, suggesting hematic contents (stars on A and C). (A,B: axial T2- weighted image with fat saturation; C,D: axial T1-weighted, in phase and out-phase images).
  14. 14. Cornual ectopic pregnancy. Pelvic MRI. The presence of a heterogeneous mass is observed in the cornual segment of the left uterine tube (white arrows on A to D). Note the communication with the uterine cavity (white hollow arrows on B and C). The myometrium is indicated by the black hollow arrow on C. (A,B: axial T1- weighted and T2-weighted images, respectively; C: post-contrast, axial T1-weighted image with fat saturation; D: coronal T2-weighted image).
  15. 15. Ectopic pregnancy with enhancing papillary solid components with a nonenhancing necrotic portion and high signal intensity on outer surface on sagittal T1-weighted turbo spin echo spectral presaturation with inversion recovery with contrast imaging (A), on coronal T1-weighted fast field echo spectral presaturation with inversion recovery with contrast imaging (B), on transverse T1-weighted fast field echo in- phase with contrast imaging (C) (black arrows).
  16. 16. Tubal pregnancy in a 41- year-old woman with acute abdominal pain and positive results of a pregnancy test.
  17. 17. CONCLUSION. Sonography plays a central role in the diagnosis and management of ectopic pregnancy. If an extraovarian mass is present in a pregnant patient with pain and bleeding, and no intrauterine gestational sac is seen, the diagnosis of ectopic pregnancy should be considered until proved otherwise. Therapy is determined by a combination of clinical symptoms, sonographic findings, and serum β-hCG values. While an intrauterine gestational sac is typically seen when the β-hCG value is greater than 2000 mIU/mL (IRP), this value should be used as a guideline and not an absolute threshold. Since the fallopian tube is the most common location of ectopic pregnancy, care should be taken while scanning to search between the uterus and ovary for a tubal mass. Surgery is being performed less often for ectopic pregnancy since the alternative treatments of expectant management, methotrexate, and percutaneous injection are now available. With these conservative treatments, there is an increased role for sonography in patient follow-up.
  18. 18. Thank You.

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