ADNEXAL SIGNS IN ECTOPIC PREGNANCY

• Pathognomonic Sign
• Extrauterine gestational sac + yolk sac or an embryo.
• Seen in 8-26% of ectopics diagnosed endovaginally (1,2)

Live rupturing ectopic pregnancy: · Adnexal mass · Fetal cardiac pulsations. · Ipsilateral corpus luteal cyst · Free fluid in the cul-de-sac

• Tubal Ring
• Extrauterine sac like structure.
• Seen in 40-68% of cases diagnosed endovaginally (1,2).
• Most tubal rings are not thick and echogenic.

Tubal Ring: · Normal right ovary. · Tubal ring adjacent to left ovary. · Tubal ring separate from ovary No free fluid in cul-de-sac

• Tubal Mass / Hematosalpinx.
• Most common endovaginal adnexal finding.
• Seen in 89-100% cases endovaginally.
• Specificity = 92-98.8% (1,3).
• Homogeneous or inhomogeneous.
• Echogenic.
• Rounded or elongated.
• Solid mass ± cystic areas.
• Extraovarian (but in close proximity).

Tubal Mass / Hematosalpinx.
	Corpus Luteum adjacent to Ectopic Pregnancy

Video clip of live Ectopic Pregnancy.

Video clip of Ectopic Gestational Sac and Yolk Sac.

Live monochorionic diamniotic twin ectopic pregnancies

Tubal Ectopic Pregnancy

– Unruptured but no fetal heartbeat.

– Ipsilateral corpus luteal cyst.

Ovarian Ectopic Pregnancy (rare)

• Gestational sac, yolk sac and fetal pole seen in the ovary.
• No fetal heart-beat could be recorded.
• Findings confirmed at laparoscopic removal.

REFERENCES

1. Atri M, deStempel J, Bret P. Accuracy of transvaginal ultrasonography for the detection of hematosalpinx in ectopic pregnancy. Radiology 1993;189:727-731.
2. Nyberg DA, Mack LA, Jeffrey RB Jr et.al. Endovaginal sonographic evaluation of ectopic pregnancy: a prospective study AJR 1987;149:1181-1186.
3. Frates MC, Brown DL, Doubilet PM et.al. Tubal rupture in patients with ectopic pregnancy: diagnosis and transvaginal ultrasound. Radiology 1994;191:769-772.