CT findings of omental pregnancy: a case report

Unruptured ovarian ectopic pregnancy: Two case reports and literature review

In clinical practice, ovarian pregnancy is extremely rare and is always found to be ruptured. A definitive diagnosis for ruptured ovarian pregnancy is difficult to obtain. We present two cases of unruptured ovarian pregnancies detected during laparoscopy and review existing literature to better understand the clinical characteristics of ectopic pregnancies in this rare site. Intrauterine devices, assisted reproductive technology, and intrauterine operations are all high-risk factors in ovarian pregnancy. Moreover, menopause, abdominal pain, and vaginal bleeding are clinical manifestations. Ovarian pregnancy can be diagnosed using serum hCG, transvaginal ultrasound, and magnetic resonance imaging. Laparoscopy is the treatment of choice for ovarian pregnancy. It is recommended that the intact gestational sac be excised and the ovarian function be protected to the greatest extent possible during the operation. More definitive diagnosis of ovarian pregnancy must be reported in order to gain a better understanding of ovarian pregnancy.

Rare Ectopic Pregnancies - A Literature Review for the Period 2007 - 2019 on Locations Outside the Uterus and Fallopian Tubes

The majority of ectopic pregnancies (EP) are tubal pregnancies, but other implantation sites outside the uterus and tubes are also found. These rare EP locations present a particular diagnostic and therapeutic challenge. We present an overview of potential very rare locations of ectopic pregnancies, their symptoms, diagnosis and treatment, based on a systematic analysis of case reports. A literature review of the databases PubMed, Livivo and Google Scholar for the period 2007 to 2019 was carried out. A total of 113 publications were included in our review. These studies describe EP implantations in the posterior cul-de-sac, on the uterine serosa and uterine ligaments, in the vicinity of almost all intraperitoneal organs, on the abdominal wall as well as in retroperitoneal sites. The most common presenting symptom was abdominal pain occurring in different locations. The diagnostic procedures included various imaging procedures and/or explorative surgery at different advanced stages of pregnancy. The most common and preferred option was laparotomy for surgical treatment. The placenta was successfully resected in the majority of cases. A rare EP location should be considered when making a differential diagnosis in patients of child-bearing age with abdominal pain.

Diagnostic utility of CT in differentiating between ruptured ovarian corpus luteal cyst and ruptured ectopic pregnancy with hemorrhage

Background

To evaluate the performance of computed tomography (CT) as a diagnostic aid to differentiate between ruptured ovarian corpus luteal cyst (ROCLC) and ruptured ectopic pregnancy with hemorrhage (REPWH).

Methods

A total of 36 patients treated at our hospitals for ROCLC and REPWH from June 2014 to August 2017 were included in this study. Based on the diagnosis, the study population was divided into ROCLC group (n = 21) and REPWH group (n = 15). CT scans were performed for all patients prior to treatment. The size of the cystic shadows and the depth of the pelvic effusion were analyzed and compared with independent sample Student’s t test and Fisher’s exact test.

Results

Cystic shadows with maximum diameters ≥3.0 cm presented in 16 patients with ROCLC and 1 patient with REPWH, while 4 patients with ROCLC and 9 patients with REPWH exhibited cystic shadows with maximum diameters <3.0 cm. The mean diameters along the major and minor axes in the two groups were 3.76 ± 1.11 cm and 2.93 ± 0.98 cm, 1.96 ± 0.65 cm and 1.60 ± 0.55 cm, respectively (p < 0.001). The mean depth of the pelvic effusion in patients with ROCLC and REPWH were 5.20 ± 2.47 cm and 6.96 ± 2.07 cm, respectively (p = 0.038).

Conclusion

The cystic shadow of ROCLC is larger than that of the REPWH. The depth of the pelvic effusion of REPWH is deeper than that of the ROCLC. CT can help differentiate between ROCLC and REPWH based on the size of the cystic shadow and the depth of pelvic effusion in the adnexal area.

Ectopic pregnancy in the liver incidentally diagnosed by imaging: A case report

The present report describes the case of a 31-year-old woman diagnosed with an ectopic pregnancy in the liver. The patient presented with amenorrhea for 40 days and abdominal distention for 27 days. A liver mass had been detected 6 days prior to presentation. Using ultrasound (US), a hyperechoic mass with a fluid sonolucent area was detected in the right hepatic lobe. Examination by computed tomography (CT) revealed the presence of a mass in the right hepatic lobe with a slightly low-density peripheral region and an oval central portion of lower density in the plain scan; the enhanced scan revealed a significantly enhanced peripheral region and a non-enhanced central portion. ¹⁸F-fluodeoxyglucose (FDG) positron emission tomography (PET)-CT showed a mass in the right hepatic lobe with an increased intake of FDG in the peripheral region (maximum standard uptake value, 5.7) and a non-increased intake of FDG in the central portion. The patient was then subjected to hysteroscopy and laparoscopy. Histopathologically, the mass was an ectopic pregnancy. The patient recovered following the surgery. In conclusion, a timely diagnosis of ectopic pregnancy was made for a 31-year-old women with an ectopic pregnancy in the liver on the basis of US, CT and PET-CT imaging results, which enabled surgery to be undertaken prior to any serious consequences. These observations may be helpful for the diagnosis of similar cases in the future.