Interstitial ectopic pregnancy

Case contributed by Dr Matthew Lukies ◉

Diagnosis almost certain

Presentation

Spotting blood per vagina for 3 weeks, then 2 days of heavy PV bleed. Crampy lower abdominal pain and diarrhoea.

Patient Data

Age: 40 year-old

Gender: Female

From the case: Interstitial ectopic pregnancy

Ultrasound

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Uterus and endometrium

anteverted uterus of normal non-pregnant size
no gestational sac within the endometrial cavity
right sided corpus luteum
approximately 2 cm rounded hyperechoic focus with a thin line of communication back to the endometrium
- there is a very thin amount of myometrium overlying the hyperechoic focus
the left ovary is unremarkable
no free fluid seen in the pelvis

Case Discussion

This case is a typical demonstration of an interstitial ectopic pregnancy, with a thin surrounding myometrial layer (myometrial mantle) and hyperechoic line from the mass to the endometrium (interstitial line sign).

The patient in this case was not on the oral contraceptive pill and had a bHCG of 1300. She was treated with IM methotrexate and serial bHCG follow up.