Clinics in diagnostic imaging (98). Heterotopic pregnancy with an intrauterine blighted ovum and a live tubal ectopic pregnancy

A 26-year-old woman who was six weeks amenorrhoeic presented with vaginal spotting and mild abdominal pain. She had been coming to the 24 hours women's clinic at two-day intervals for the past week with the same symptoms. Ultrasonography two days ago showed one intrauterine gestational sac (IUGS) with a yolk sac within. Her pregnancy was clomiphene-related. Repeat transvaginal ultrasonography during this admission showed an IUGS, together with a left live tubal ectopic pregnancy. Heterotopic pregnancies used to be a rare entity. Now, given the increasing rise in assisted reproduction techniques, there should be a high index of suspicion for heterotopic pregnancy as this would impact upon clinical management. The ultrasonographical features of heterotopic pregnancy and its differential diagnoses are discussed.