Ultrasound Case of the Week

Kudos to Dr. Castleberry for getting these images!!
With the early diagnosis of this ectopic pregnancy in Supertrack, her obstetric care was expedited.

1ST trimester ultrasound (transabdominal)
1. Images- transverse to start just above the pubic symphysis
-scan through all planes then turn longitudinal (indicator to 12 o’clock)
Sagittal- the uterus will be left of bladder on the screen. Vaginal canal and endometrial stripe appears inferiorly.
A full bladder will help aide your views

2. Signs of Definitive IUP:
A. Double decidual sign - formed when an implementation occurs , but not definitive
B. gestational sac not sufficient bc an ectopic can produce a gestational sac due to hormonal response (see image)
C. Yolk Sac- looks like a loop/ring/balloon. definitive sign of pregnancy. 
     Note- mean sac diameter of 8-10mm should have a yolk sac
D. Fetal pole - definitive iup
     Note- a fetal pole>5mm should see cardiac activity

3. Signs of Ectopic: 
A. Always concerned if have +pregnancy test and no intrauterine pregnancy
B. If no iup- scan adnexa. Can see an adnexal mass with possible evidence of yolk sac and even fetal pole. 
C. Free fluid likely seen
D. If you like it then you should put color on it - ectopics cause inflammation and hypervascularity it’ll light up around it. What’s called the “ring of fire “

Please note- if +pregnancy and no iup: A lack of adnexal mass on transabdominal ultrasound does NOT rule out an ectopic. Need to get transvaginal to confirm.

This patient- Image 1: uterus with pseudogestational sac and free fluid
Image 2- adnexal mass and possibly fetal pole (top left of video).

Happy Scanning!

Janel Paukovits