title: Atypical presentation of a large interstitial pregnancy.
abstract: We report the case of a 20-year-old female who presented to the ER with a 1-week history of worsening abdominal pain and intermittent vaginal bleeding for the previous 5 days. Physical exam was notable for bilateral adnexal tenderness and a closed cervix without motion tenderness or discharge. Laboratory data demonstrated a beta HCG level of 7,787 IU/L, and pelvic ultrasound with transvaginal imaging was subsequently performed. Neither an adnexal mass nor a normal intrauterine pregnancy was demonstrable; however, a focal right fundal 7-cm area of heterogeneous echogenicity was observed. Initial findings were felt indeterminate with considerations including potential degenerating leiomyoma coexistent with a nonvisualized intrauterine pregnancy, ectopic pregnancy, or recent spontaneous abortion versus atypical interstitial ectopic pregnancy. The patient, initially declining further clinical intervention, returned within 24 h with continued pain. A repeat ultrasound demonstrated a relatively static and unchanged appearance with only a minimal concurrent interval increase in beta HCG levels. MRI was performed for further elucidation and demonstrated a heterogeneously hypervascular right fundal interstitial 6-cm mass, which, in the clinical context, was most suspicious for an ectopic pregnancy. Confirmatory laparoscopic cornual wedge resection and salpingectomy was subsequently performed.
authors.affiliation: Department of Emergency Radiology, Henry Ford Hospital, Detroit, MI, USA. mrheinbold@yahoo.com
authors.forename: Matthew
authors.initials: M
authors.lastname: Rheinboldt
authors.forename: Sherif
authors.initials: S
authors.lastname: Ibrahim
mesh_terms: D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D058994:Salpingectomy; D014463:Ultrasonography; D055815:Young Adult