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The Ultrasonographic Appearance of Ovarian Ectopic Pregnancies

Christine Comstock, MD^*, Kathleen Huston, MD and Wesley Lee, MD^*

From the *Division of Fetal Imaging and Department of Obstetrics and Gynecology, William Beaumont Hospital, Royal Oak, Michigan; and Departments of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, and University of Michigan, Ann Arbor, Michigan.

Address reprint requests to: Christine Comstock, MD, Division of Fetal Imaging, William Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak MI 48009; e-mail: ccomstock{at}beaumont.edu.

OBJECTIVE: To evaluate the ultrasonographic findings of ovarian ectopic pregnancies.

METHODS: The ultrasonographic reports, videotapes, medical records, and operative summaries were reviewed for all women with a confirmed diagnosis of an ovarian ectopic pregnancy. Examinations were personally conducted by a physician who was either a radiologist-obstetrician or an obstetrician-maternal-fetal medicine specialist

RESULTS: Six cases were identified in the 13-year period studied. Menstrual ages ranged from 6 to 9 2/7 weeks. Most (5/6) patients had abdominal pain, with 3 demonstrating it before or at 7 weeks gestation. A wide echogenic ring with an internal echolucent area was seen in 5 of 6 patients; 1 of these also contained a yolk sac, and in another, fetal heart motion could be seen. The echogenic ring seemed to be on the surface of the ovary or within the substance of the ovary in all 5 patients. The echogenicity of the ring was greater than that of the ovary in the 5 patients in whom it was identified. At surgery, the ovarian pregnancies had the appearance of a hemorrhagic ovarian cyst in all 6 patients. In the patient in whom no echogenic ring was seen the pregnancy had ruptured. All 6 cases were biopsy proven.

CONCLUSION: Ovarian pregnancies usually appeared on or within the ovary as a cyst with a wide echogenic outside ring. A yolk sac or embryo was less commonly seen. The appearance of the contents lagged in comparison with the gestational age. Early abdominal pain was common.

LEVEL OF EVIDENCE: III