Heterotopic pregnancy CT….

22-year old female came in with RLQ pain and a reported ultrasound positive intrauterine pregnancy a week ago, a visit two days ago consistent with spontaneous incomplete Ab on ultrasound.  On exam her RLQ was very tender, US showed minimal blood products in uterine cavity no IUP.  Serum beta-Hcg >5000. 

CT abdomen/pelvis:

Ectopic 1 Ectopic 2

CT shows fluid in pelvis with consistent with blood and has a right adenexal hemorrhagic mass consistent with ruptured ectopic pregnancy.

This patient, by history, had a documented intrauterine pregnancy that resulted in a spontaneous abortion.  She had the feared Heterotopic pregnancy.  Heterotopic pregnancy is when a dual gestation occurs, one in the uterus and one in the fallopian tube in an ectopic location.  It is very rare although seen in increasing prevalence with the advent of ovulation induction drugs (she was not taking these drugs!). 

Author:  Russell Jones, MD

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