Abstract
We report a case of ruptured tubal pregnancy with massive life-threatening hemoperitoneum. The 38 year-old woman presented with gynaecologic haemorrhage, pelvic pain and hypovolemic shock. Without any ambiguity, the diagnosis was directly made during contrast enhanced Multidetector Computed Tomography (MDCT). Massive hemoperitoneum with fresh blood clots in the hypogastric area, active free peritoneal extravasation of intravascular contrast material and dramatic peripheral enhancement, - “ring of fire” sign - of an adnexal cystic structure were the key signs. These signs must be known by the emergency radiologist because of the more and more use of CT as the first imaging modality in emergency departments particularly for patients with abdominal pain and presenting life-threatening symptoms.
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References
Lubner M, Menias C, Rucker C, Bhalla S, Peterson CM, Wang L, Gratz B (2007) Blood in the belly: CT findings of hemoperitoneum. Radiographics 27:109–125
Hertzberg BS, Kliewer MA, Bowie JD (1999) Adnexal ring sign and hemoperitoneum caused by hemorrhagic ovarian cyst: pitfall in the sonographic diagnosis of ectopic pregnancy. AJR Am J Roentgenol 173:1301–1302
Hertzberg BS, Kliewer MA, Paulson EK (1999) Ovarian cyst rupture causing hemoperitoneum: imaging features and the potential for misdiagnosis. Abdom Imaging 24:304–308
Pham H, Lin EC (2007) Adnexal ring of ectopic pregnancy detected by contrast-enhanced CT. Abdom Imaging 32:56–58
Condous G (2006) Ectopic pregnancy-risk factors and diagnosis. Aust Fam Physician 35:854–857
Andolsek KM (1987) Ectopic pregnancy: classic versus common presentation. J Fam Pract 24:481–485
Corpa JM (2006) Ectopic pregnancy in animals and humans. Reproduction 131:631–640
Graczykowski JW, Seifer DB (1999) Diagnosis of acute and persistent ectopic pregnancy. Clin Obstet Gynecol 42:9–22
Wong E, Suat SO (2000) Ectopic pregnancy—a diagnostic challenge in the emergency department. Eur J Emerg Med 7:189–194
Luciano DE, Jain A, Roy G, Solima E, Luciano AA (2004) Ectopic pregnancy—from surgical emergency to medical management. J Am Assoc Gynecol Laparosc 11:107–121
Frates MC, Visweswaran A, Laing FC (2001) Comparison of tubal ring and corpus luteum echogenicities: a useful differentiating characteristic. J Ultrasound Med 20:27–31
Stein MW, Ricci ZJ, Novak L, Roberts JH, Koenigsberg M (2004) Sonographic comparison of the tubal ring of ectopic pregnancy with the corpus luteum. J Ultrasound Med 23:57–62
Federle MP (2005) CT of the acute (emergency) abdomen. Eur Radiol 15:100–104
Leschka S, Alkadhi H, Wildermuth, Marincek B (2005) Multi-detector computed tomography of acute abdomen. Eur Radiol 15:2435–2447
Orwig D, Federle MP (1989) Localized clotted blood as evidence of visceral trauma on CT: the sentinel clot sign. AJR Am J Roentgenol 153:747–749
Shanmuganathan K, Mirvis SE, Reaney SM (1995) Pictorial review: CT appearances of contrast medium extravasations associated with injury sustained from blunt abdominal trauma. Clin Radiol 50:182–187
Jeong YY, Outwater EK, Kang HK (2000) Imaging evaluation of ovarian masses. Radiographics 20:1445–1470
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Coulier, B., Malbecq, S., Brinon, PE. et al. MDCT diagnosis of ruptured tubal pregnancy with massive hemoperitoneum. Emerg Radiol 15, 179–182 (2008). https://doi.org/10.1007/s10140-007-0666-1
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DOI: https://doi.org/10.1007/s10140-007-0666-1