SONOWORLD : Cornual (interstitial) ectopic pregnancy

Username

Password

185,236 Registered Members as of 01/18/2021.

JavaScript must be enabled in order for you to use Sonoworld.com in standard view. However, it seems JavaScript is either disabled or not supported by your browser. To use standard view, enable JavaScript by changing your browser options, then try again.

Obstetrics » Obstetrics 1st Trimester

Cornual (interstitial) ectopic pregnancy

« Back to Listing

Author(s) :

Sheila Sheth, MD

Presentation A young woman presented with a 2 day history of right lower quadrant pain. Her last menstrual period was 3 months ago. She had no vaginal bleeding. Her urine HCG was positive.

Caption: Sagittal endovaginal image of the uterus.

Description:

Caption: Sagittal endovaginal image of right ovary.

Description: There is a small corpus luteum.

Caption: Coronal endovaginal image of right cornual region.

Description: There is a complex cystic mass with an echogenic rim compatible with a gestational sac intimately related to the uterus. Note myometrium does not completely surround the gestational sac.

Caption: Transverse endovaginal image of right cornual region.

Differential Diagnosis Tubal ectopic pregnancy
Eccentrically located intrauterine pregnancy
Intrauterine pregnancy in a bicornuate uterus.

Final Diagnosis Right cornual (interstitial) ectopic pregancy

Discussion The overwhelming majority of extrauterine gestations occur in the ampullary portion of the fallopian tube. Ectopic pregnancies that implant in the interstitial (cornual) portion of the fallopian tube represent only 2 to 4.7% of all ectopic gestations. Risk factors include previous salpingectomy and assisted reproduction. Despite their rarity, they pose a significant diagnostic and therapeutic challenge and carry a greater maternal mortality risk (up to 2.2%) then ampullary ectopic pregnancies. Because of myometrial distensibility, cornual pregnancy tend to present relatively late, at 7 to 12 weeks gestation. Significant maternal hemorrhage leading to hypovolemia and shock can result from cornual rupture.

Evaluation with endovaginal sonography allows accurate diagnosis which is critical for management. One study has shown that early diagnosis of cornual pregnancy with EVS allows for first trimester conservative management with methotrexate. If the diagnosis is made later in gestation, however, surgical treatment with cornual resection or even hysterectomy may be required.

The sonographic findings of cornual pregnancy include:
· Absence of a normally positioned intrauterine pregnancy
· Heterogeneous mass in the cornua
· Eccentrically placed gestational sac with myometrial mantle surrounding only portion of the gestational sac. The gestational sac is usually in the lateral portion of the uterus early in gestation but in advanced cornual pregnancies, the gestational sac may be located above the uterine fundus and may be confused with an eccentric intrauterine pregnancy.
· “Interstitial line" sign

Case References 1. Ackerman, TE, CS Levi, SM Dashefsky, SC Holt and DJ Lindsay: Interstitial line: sonographic finding in interstitial (cornual) ectopic pregnancy. Radiology, 1993. 189(1): p. 83-7.
2. Benifla, JL, H Fernandez, E Sebban, E Darai, R Frydman, and P Madelenat: Alternative to surgery of treatment of unruptured interstitial pregnancy: 15 cases of medical treatment. Eur J Obstet Gynecol Reprod Biol, 1996. 70(2): p. 151-6.
3. Bouyer, J, J Coste, H Fernandez, JL Pouly and N Job-Spira: Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod, 2002. 17(12): p. 3224-30.
4. Chen, GD, MT Lin and MS Lee, Diagnosis of interstitial pregnancy with sonography. J Clin Ultrasound, 1994. 22(7): p. 439-42.
5. Jafri, SZ, SJ Loginsky, JA Bouffard and JE Selis: Sonographic detection of interstitial pregnancy. J Clin Ultrasound, 1987. 15(4): p. 253-7.
6. Lemus, JF: Ectopic pregnancy: an update. Curr Opin Obstet Gynecol, 2000. 12(5): p. 36

Follow Up The patient underwent laparotomy with removal of the pregnancy and wedge resection of the right cornua.

Other contents by this AuthorOther Cases in This Category

Obstetrics >> Obstetrics 1st Trimester

Retained products of conception
An ultrasound was performed to evaluate this young woman with vaginal bleeding for 2 weeks following a spontaneous abortion. B-HCG level has been slowly dropping.

Rupturing ectopic pregnancy
A 25 year old female presented with a history of amenorrhea for one month. She now complains of vaginal bleeding and acute left lower quadrant pain. Her urine pregnancy test is positive.

Molar pregnancy
A 54 year old woman presents with a 2 month history of amenorrhea. She now complains of severe vaginal bleeding and abdominal pain. She has a beta HCG level of approximately 200,000 units.

Molar pregnancy II
A 28 year old female presents with severe first trimester nausea and vomiting [hyperemesis gravidarum]. Her beta HCG titers are very high in the range of hundreds of thousands units.

Ectopic pregnancy
A 20 year old woman presents with right adnexal tenderness and positive urinary beta- HCG test.

Embryonic demise and spontaneous abortion in progress
A young woman with a history of positive pregnancy test presents with vaginal bleeding of one day duration. The pregnancy should be at 12 weeks gestation according to her last menstrual period. ...

Partial molar pregnancy
A 39 year old woman, 11 weeks pregnant, presents with vaginal bleeding. The patient had very high levels of beta-HCG and a pelvic ultrasound was performed.

Live ectopic pregnancy
A young woman presents with a two month history of amenorrhoea. She now complains of pain in the left lower quadrant for the past 24 hours.

Heterotropic pregnancy -intrauterine and left tubal ectopic
A 25 year old woman presents with eight weeks amenorrhea and acute onset of pain in the lower abdomen.

Molar pregnancy at 6 weeks
A 22 year old woman presents to the ER with a history of nausea and amenorrhea for six weeks. Her quantitative beta HCG was 104,000 mIU. She was referred for a pelvic ultrasound.

Laminated blood clot in the uterine cavity
A young woman presents with on-going bleeding per vaginum since dilatation and curettage that was done 4 weeks ago for a missed abortion. An ultrasound scan done 2 weeks earlier showed no ...

Complete hydatidiform mole
A 21 year old woman, primigravida, with history of 3 months amenorrhoea presents with vaginal bleeding.

Tubal ectopic gestation with hemosalpinx
A young woman presents with history of amenorrhea, severe abdominal pain and vaginal bleeding. Her pregnancy test is positive.

Conjoined twins in cephalopagus
This is an ultrasound scan performed in the first trimester pregnancy of an asymptomatic woman. The images obtained in 3-D format are shown here.

Cystic hygroma
This is a routine ultrasound examination at 11 weeks of gestation.

Bilateral ectopic pregnancy
This is the scan in a patient with bilateral tubo-ovarian masses and pain in the abdomen. Her past history was significant for an operated ruptured ectopic 2 years ago. Her current Beta-HCG ...

Perforated uterus with expelled fetus
This scan was performed following an attempted D and C that was performed by an untrained ‘health provider’ in a rural town at 13 weeks of gestation.

Intrauterine contraceptive device and pregnancy
A 28 year-old woman, G2-P1 presented with complaints of amenorrhea for 2 months. She has a history of insertion of an intrauterine contraceptive device [copper - T] 2 years ago.

Cornual pregnancy
The patient, a 35 year old lady having history of 3 vaginal deliveries (P 3) is a known case of severe mitral stenosis. She presented with abdominal pain which is more intense in lower abdomen ...