title: A unique case of ruptured ectopic pregnancy in a patient with negative preg-nancy test - a case report and brief review of the literature.
abstract: BACKGROUND
  Despite the major advances made in the diagnosis and management of ectopic pregnancies in the last two decades, an accurate diagnosis can sometimes still be quite challenging, since it relies on the combination of ultrasound findings and serial serum beta-human chorionic gonadotrophin (β-hCG) measurements.
  
  
  METHODS
  This paper describes the case of a 36-year-old woman of Caucasian origin who was admitted to the emergency department of our clinic with clinical symptoms of hemorrhagic shock in combination with two negative pregnancy tests done by her at home and a negative urine test which was performed on her admission to the hospital. Quantitative measurement of β-hCG in the serum of the patient was 13 mIU/mL. On admission, right tubal pregnancy was diagnosed on ultrasound and she underwent an emergency laparotomy due to signs of hemodynamic shock.
  
  
  CONCLUSIONS
  It is sometimes a considerable challenge to identify a patient with an ectopic pregnancy at risk of rupture. This case of ectopic pregnancy which was followed by a negative pregnancy test illustrates the magnitude of the difficulties involved in the diagnosis of ectopic pregnancy. It also demonstrates the need to maintain a high clinical index of suspicion and to undertake careful clinical examination of the patient on the basis of the clinician's diagnostic research. Hippokratia 2014; 18 (3): 282-284.
authors.affiliation: 2 University Department of Obstetrics and Gynecology, Hippokrateio General Hospital, Aristotle University of Thessaloniki, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Daniilidis
authors.affiliation: 2 University Department of Obstetrics and Gynecology, Hippokrateio General Hospital, Aristotle University of Thessaloniki, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Pantelis
authors.affiliation: 2 University Department of Obstetrics and Gynecology, Hippokrateio General Hospital, Aristotle University of Thessaloniki, Greece.
authors.forename: V
authors.initials: V
authors.lastname: Makris
authors.affiliation: 2 University Department of Obstetrics and Gynecology, Hippokrateio General Hospital, Aristotle University of Thessaloniki, Greece.
authors.forename: D
authors.initials: D
authors.lastname: Balaouras
authors.affiliation: 2 University Department of Obstetrics and Gynecology, Aretaieio General Hospital, Kapodistrian University of Athens, Greece.
authors.forename: N
authors.initials: N
authors.lastname: Vrachnis
keywords: Ectopic pregnancy; beta human chorionic gonadotrophin; hemorrhagic shock; β-hCG