A Case of Ovarian Pregnancy Diagnosed by MRI

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.

Surgical Treatment of Ovarian Pregnancy

The description of this case concerns the early diagnosis and the surgical treatment of a patient diagnosed with an ectopic ovarian pregnancy. A gravida 2, para 0 woman with a history of termination of pregnancy in the second trimester, was referred to the outpatients of the Gynecologic Department of the General Hospital of Trikala, reporting vaginal bleeding, accompanied by a deep, mild pain in the abdomen for a few days. The urine pregnancy test was positive. The transvaginal ultrasound in combination with the β-chorionic gonadotropin level was indicative of an ectopic pregnancy, and the surgical treatment of the patient was decided. Intraoperatively, the presence of an ovarian ectopic pregnancy was detected, and a wedge resection of the affected ovary was performed. The patient was discharged from our clinic on the third postoperative day, with instructions for weekly follow-up of the β-chorionic gonadotropin level until it returns to normal values.

To evaluate the feasibility of magnetic resonance imaging in predicting unusual site ectopic pregnancy: a retrospective cohort study

OBJECTIVE

To evaluate the accuracy of pelvic MRI in the diagnosis of unusual ectopic pregnancy (EP), when ultrasound (US) examination is inconclusive.

METHODS

We retrospectively reviewed the medical records of 150 patients with suspected EP. Clinical, US and MRI features of 15 unusual EPs were analysed. Two radiologists independently reviewed each case resolving by consensus any diagnostic discrepancy. Interobserver agreement was assessed using the Cohen κ test.

RESULTS

MRI displayed a gestational sac-like structure surrounded by a thick wall in all cases. The thick wall displayed hyperintensity in 41 %, isointensity in 35 % and hypointensity in 24 % of cases on T1-weighted images. Diffusion- and fat saturation T1-weighted images were the most accurate sequences, as they enabled identification of 15/15 and 14/15 patients, respectively. Although US was false negative in detecting cervical and uterine infiltration underlying the caesarean scar, MRI was able to identify the invasion. Interobserver agreement was very good for all sequences (κ=0.892-1.0).

CONCLUSIONS

MRI plays an important role in the early diagnosis of unusual EP. It should be considered after negative US findings, providing accurate evaluation of the site and the possible infiltration of these lesions, which help in the management of these patients.

KEY POINTS

• MRI is being increasingly used as a problem-solving modality in ectopic pregnancy. • MRI plays an important role in early diagnosis of unusual ectopic pregnancy. • Knowledge of MRI features in EP is essential to determinate appropriate management.