E5059. Pearls and Pitfalls of First Trimester Ultrasound: A Case-Based Resident Primer
Authors
Adela Pouzar;
Corewell Health William Beaumont University Hospital
Monisha Shetty-; ;
Corewell Health William Beaumont University Hospital
Jonathan Chapman;
Corewell Health William Beaumont University Hospital
Zachary Dreyer;
Corewell Health William Beaumont University Hospital
Background
Pelvic ultrasonography is the primary imaging modality used to evaluate pregnancy, and symptomatic patients often present to the emergency department. In this setting, radiology residents often play a crucial role in detecting early pregnancy, evaluating maternal symptoms, assessing viability, and evaluating potential complications.
Educational Goals / Teaching Points
Familiarity with the appearance of a normal viable intrauterine pregnancy and the diagnostic criteria of failed pregnancy are important for the interpreting radiologist. An understanding of early pregnancy development, findings of failed pregnancy, poor prognostic factors, and the diagnosis of pregnancy of uncertain location are essential to accurate and timely patient management. Also, radiology residents must be familiar with technical parameters of first trimester ultrasound to ensure that the images are appropriately acquired by the sonographers, to avoid misdiagnosis.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
In this cased-based multiple choice presentation, we present a review highlighting pearls and pitfalls of first trimester ultrasound with which radiology trainees should be familiar. Cases are classified into categories as follows: a) diagnostic criteria of failed pregnancy, and suspicious findings for failed pregnancy (first trimester oligohydramnios, chorionic bump, or abnormal sac appearance); b) technical errors, such as mismeasured yolk sac, maternal heart rate on M-mode (example case), use of power Doppler on embryo; c) ectopic pregnancy (interstitial, cervical, C-section ectopic pregnancy, ruptured ectopic pregnancy, complex adnexal mass representing ectopic pregnancy, and heterotopic pregnancy); d) miscellaneous cases, including abortion in progress (example case), gestation trophoblastic disease, twin peak sign, ring of fire and slide sign, subchorionic hemorrhage, and pregnancy of uncertain location. Each case is followed by an explanatory slide with dedicated discussion regarding the covered topic.
Conclusion
Radiology residents play a key role in detecting early pregnancy, evaluating maternal symptoms, assessing viability, and evaluating for potential complications in the acute setting. This review will highlight various pearls and pitfalls encountered when evaluating first trimester ultrasound.
