ARRS 2022 Abstracts

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E1809. Don’t Miss These Killers: Unusual Ectopic Pregnancies
Authors
  1. Kali Xu; University of California San Francisco
  2. Dorothy Shum; University of California San Francisco
Background
Ectopic pregnancy is a life-threatening emergency and is the leading cause of maternal mortality in the first trimester of pregnancy. Early recognition of ectopic pregnancy is essential to provide appropriate treatment and avoid complications. Although 95% of ectopic pregnancies occur in the fallopian tubes, most commonly in the ampulla, there are several other possible implantation sites and diagnosis of ectopic pregnancy in these uncommon sites can be challenging. Correct localization is important because clinical management can differ depending on the implantation site. Familiarity with characteristic imaging findings is important to help facilitate accurate diagnosis.

Educational Goals / Teaching Points
We aim to provide a review of unusual locations of ectopic pregnancies, including ovarian, interstitial, intramural, cervical, Cesarean section scar, and abdominal implantations. We will also review heterotopic pregnancies. We will discuss imaging findings, possible complications, and expected management of these findings.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit will utilize a case-based approach to review unusual ectopic implantation locations. We will provide illustrative examples and describe pearls and pitfalls in differentiating these locations, as well as clinical implications. For example, ovarian ectopic pregnancies can appear very similar to corpus lutea but generally have a thicker and more echogenic surrounding ring and can be seen along with a corpus luteum in the same ovary. There is risk of rupture or torsion with ovarian ectopic pregnancies and treatment is surgical, so recognizing an ovarian ectopic is critical. As another example, cervical ectopic pregnancies can be easily confused with spontaneous abortions in progress but exhibit subtle differences such as increased surrounding vascularity and lack of sliding movement of the gestational sac within the endocervical canal. Misdiagnosis of a cervical ectopic as a spontaneous abortion in progress and subsequent treatment with dilation and curettage can lead to life-threatening hemorrhage. Knowledge of key ultrasound anatomical findings and visualization techniques as demonstrated by our case series will help viewers avoid pitfalls in diagnosis. We will show correlative CT and MRI images where applicable and review possible associated complications including torsion, rupture, and hemorrhage.

Conclusion
Early diagnosis of ectopic pregnancy can avoid significant maternal morbidity and mortality. This exhibit will review uncommon implantation locations and highlight key findings to help identify and localize ectopic pregnancies and their potential complications.