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21 year old female, pelvic pain
Representative Image of Uterus (sagittal)
DDx? Further studies, course of action?
F/U trans-vaginal US (Rt. Adnexal area)
Final Dx, Recommendations?
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Answers
Ectopic Pregnancy (unruptured)
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  • Reproductive age female, positive pregnancy test, cystic structure in right adnexa, clearly thickened endometrial stripe (decidual reaction), but apparently empty uterus
  • Ectopic Pregnancy until Proven Otherwise
  • However, this could also be an early IUP with a corpus luteum cyst, or an abnormal IUP (i.e, miscarriage)
  • A normal IUP should be visualized when β-HCG >= 6,500 mIU/mL (transabdominal) or >=2,000 -3,000 mIU/mL (by transvaginal)
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  • Visualization of fetal pole in mass, w/ heartbeat (*not shown) clinches the diagnosis
  • ”Pseudogestational Sac” refers to fluid within otherwise empty uterine cavity
  • Risk factors: prior tubal surgery, PID (especially Chlamydia), in-vitro fertilization, endometriosis, prior ectopic, current use of IUD, advanced age
  • Note that in an ectopic, β-HCG rises more slowly than with an IUP
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