Ectopic pregnancy: features at transvaginal sonography.

A retrospective review of the transvaginal sonograms of 50 women with laparoscopically confirmed ectopic pregnancy was performed to determine whether certain sonographic findings can be detected to confirm the diagnosis. Forty-seven of the 50 pregnancies were tubal. A tubal ring (a 1-3-cm mass consisting of a 2-4-mm concentric, echogenic rim of tissue surrounding a hypoechoic center) was seen in 23 of 34 (68%) ectopic pregnancies in which the fallopian tube had not ruptured, and the tubal ring could be distinguished from a corpus luteum cyst in most cases. Transvaginal sonography also depicted simple (n = 22) or particulate (bloody) (n = 13) peritoneal fluid associated with ectopic pregnancy. In each case in the series, at least one abnormal uterine, adnexal, or peritoneal finding was detected at transvaginal sonography. Because of its improved resolution of uterine and adnexal structures, transvaginal sonography is recommended as a means for detailed evaluation of patients suspected of having an ectopic pregnancy.     

Ectopic pregnancy: duplex Doppler evaluation

Of 398 patients in whom there was a clinical suspicion of ectopic pregnancy, 96 (24%) were found to have the condition. Of the 96, 70 underwent duplex Doppler imaging. A viable ectopic fetus was seen in 10 of 70 (14%), and an extrauterine sac without an identifiable fetus was seen in an additional 27, giving a sensitivity for imaging alone of 53%. Fetal heart activity was detected with Doppler in 13 (19%). High-velocity flow, which suggested the presence of an ectopic pregnancy, was detected in 38 of 70 (54%) patients (total preoperative sensitivity, 73%). In the 91 patients who did not have an ectopic pregnancy, duplex Doppler imaging of the intrauterine contents alone allowed an ectopic pregnancy to be excluded in 29 (32%) on the first examination and in a further 21 on the second scan (specificity, 55%). Nine vascular adnexal masses were falsely considered to be ectopic pregnancies (specificity, 90%). The positive predictive values were 47% for imaging alone and 85% for Doppler. The negative predictive values were 60% for imaging alone and 81% for Doppler.     

Ectopic pregnancy: a malpractice paradigm

Subtle sonographic findings and other nonspecific clinical presentations often lead to missed diagnoses that can have significant legal implications. This communication discusses current diagnostic and laboratory methods used to evaluate patients with a suspected ectopic pregnancy in light of the concepts of "missed lesions" as they relate to negligence and malpractice theory.     

Ectopic pregnancy: a pictorial review

Ultrasound has remained the primary modality for investigating the pelvis of women in the reproductive age group, especially in an emergency setting. Recognition of different sonographic presentations, including typical and atypical findings of ectopic pregnancy, is important to determine surgical or nonsurgical management. This pictorial review article will exemplify different sonographic presentations of ectopic pregnancy.     

Ectopic pregnancy: evolution after treatment with transvaginal methotrexate.

A prospective study was performed with 25 patients with ectopic pregnancies (EPs) who underwent treatment with transvaginal administration of methotrexate. Nineteen patients (76%) had positive responses to this treatment, and six (24%) had to undergo surgery: five because of increasing abdominal pain and one because of vaginal bleeding. The ultrasonographic (US) resolution of the EP was long and lagged behind the resolution at testing of levels of beta subunit of human chorionic gonadotropin (beta-hCG) in all patients. The fallopian tube in 12 (63%) of the responding group initially increased in diameter from a mean of 2.22 cm to a mean of 3.84 cm. In 13 (68%) of the responding group, it became more vascular at color Doppler examination. Eleven (92%) of the 12 EPs that increased in size also became more vascular. The increase in tubal size and vascularity, in spite of the falling beta-hCG level, represents a healing process and should cause no concern about the follow-up of these patients.     

Ectopic pregnancy: evaluation with endovaginal color flow imaging.

Endovaginal sonography and endovaginal color flow imaging were compared in 155 patients with clinical suspicion of ectopic pregnancy. Sixty-five patients (42%) had surgically confirmed ectopic pregnancies. Thirty-six of the pregnancies were diagnosed with endovaginal sonography alone, the criteria being an extrauterine sac or ectopic fetus (sensitivity, 54%). Sixty-two ectopic pregnancies were diagnosed with endovaginal color flow imaging (sensitivity, 95%) when an ectopic fetus or sac was seen or placental flow was identified in an adnexal mass separate from the ovary and uterus. The diagnosis of ectopic pregnancy was excluded with endovaginal sonography (specificity, 98%) and endovaginal color flow imaging (specificity, 98%) by finding an intrauterine gestation, nonvisualization of an adnexal mass, and absence of placental flow. Three false-positive and three false-negative diagnoses were made with endovaginal color flow imaging (positive predictive value, 97%). The addition of color Doppler flow imaging to endovaginal sonography allows increased sensitivity in the detection of ectopic pregnancy.     

Ectopic pregnancy: surgical-pathologic correlation with US

The ultrasound (US) examinations of 53 patients with proved ectopic pregnancy were reviewed and compared with surgical and pathologic findings. The most common finding with US and surgery was free fluid. Hematosalpinx tended to have sharply defined margins, whereas free pelvic hematomas were poorly defined or filled the pelvis. The echogenicity of the clots was variable but generally in the same range of echogenicity as the uterus. A prominent decidual reaction occurred in 26% of the patients and had a variety of appearances.     

Incarcerated Spigelian hernia: ultrasonic differential diagnosis.

The gray scale ultrasonic findings in a case of incarcerated Spigelian hernia are presented. This hernia is uncommon, and the clinical diagnosis can be difficult. The appearance of the lesion is compared with others in and about the abdominal wall, including rectus sheath hematoma, seroma, abscess, peritoneal tumor implants, and pseudocyst at the end of a ventriculoperitoneal shunt. Clinical and sonographic differentiation is emphasized.     

异位妊娠并宫腔假妊娠囊1例

患者 女性，32岁，停经56天，阴道少许出血4天，无腹痛，尿HCG（＋）。     

Candida esophagitis: accuracy of radiographic diagnosis

Candida esophagitis was diagnosed radiographically in 106 patients. Endoscopy was performed in 32 of these patients, and the diagnosis was confirmed in 27. The diagnosis was missed radiographically in seven other cases proved endoscopically. Thus, Candida esophagitis was diagnosed on esophagography in 80% (27/34) of proved cases, with five false-positive examinations. Single-contrast technique was employed in nine cases with a sensitivity of 55%, and double-contrast technique was used in 25 cases with a sensitivity of 88%. With double-contrast technique, esophagography appears to be a more accurate method for diagnosing Candida esophagitis than has been suggested in the literature.     

Ectopic pregnancy: Value of transabdominal sonography without deliberate bladder distention

We reviewed 19 consecutive patients with ectopic pregnancy in whom pelvic sonography demonstrated findings highly predictive of the diagnosis. The correct diagnosis was established by transabdominal sonography without attempting bladder distention in 12 patients (63%); the bladder was full in only one patient. Transabdominal sonography performed without waiting for the bladder to fill and thus with no delay or patient discomfort can establish the presence of ectopic pregnancy and obviate the need for transvaginal sonography in a substantial proportion of patients in whom the diagnosis can be made sonographically. In patients at risk for ectopic pregnancy, we recommend that transabdominal sonography without waiting for bladder distention be attempted before transvaginal sonography is performed.     

Duplex carotid sonography: criteria for stenosis, accuracy, and pitfalls

Both carotid bifurcations were examined in 353 patients over a 20-month interval using a combination of real-time and pulsed Doppler ultrasound (duplex scanning). Angiographic correlation was available in 72 cases. Stenosis of the internal carotid was evaluated using a Doppler input frequency of 5 MHz and a scan angle of 60 degrees. A peak frequency shift of less than 3.5 kHz was found to be a sign of less than or equal to 30% stenosis; 3.5-4 kHz with moderate turbulence suggested 31-50% stenosis, 4-8 kHz 51-90% stenosis, and greater than 8 kHz greater than 90% stenosis. Subtotal stenosis (greater than 95%) was manifested by a frequency shift of less than 8 kHz, but the waveform was totally distorted. Overall accuracy improved from 77% for the first 6 months to 87% for the last 14 months. For stenosis greater than 50%, sensitivity improved from 82% to 97% during this period. Analysis of errors and suggestions for avoiding them are presented.