28th Jun 2021

ICRI CASE OF THE WEEK

Contributed by- Dr Srinivas Dandamudi
Consultant Radiologist

Aayush Hospitals, Vijayawada

Copyright : Dr Srinivas Dandamudi
Email : [email protected]

Where is the gestational sac ?

Which of the following statements is
FALSE regarding beta HCG levels in

pregnancy ?

A. They start to decline after 30 weeks

B. Average doubling time in intrauterine viable
pregnancy is 48 hours.

C. If they fail to double in in 48 hours then
pregnancy mostly is non viable

D. 20 percent of the ectopic gestations will
show doubling of levels just like intrauterine
gestation.



What is the diagnosis ?

A. Interstial pregnancy
B. Cornual pregnancy
C. Angular pregnancy
D. All of the Above

Interstial Pregnancy

• Interstitial pregnancies are uncommon,
accounting for 2%–4% of all ectopic pregnancies

• Interstitial pregnancies occur when the
gestational sac implants in the intramyometrial
segment of the fallopian tube

• Rupture of an interstitial pregnancy can lead to
life-threatening haemorrhage because of the
proximity of the uterine artery to the fallopian
tube

• Interstitial ectopic pregnancy is associated
with a higher risk of shock and
hemoperitoneum than other forms of ectopic
pregnancy, as well as with a higher risk of
maternal mortality due to delayed diagnosis
and high vascularity of the myometrium

• The presence of an eccentrically located
gestation sac with incomplete or asymmetric
myometrial tissue, < 5 mm in thickness, is a
highly suggestive but nonspecific indicator of
interstitial pregnancy.

The Term "Cornual Pregnancy" Should Be Abandoned – Oksana
Baltarowich -

J Ultrasound Med 2017; 36:1081–1087

The term “cornual pregnancy” is a descriptive term
depicting a bump or mass effect on the external
surface of the uterus in the cornual region, as it is
visible to the surgeon, laparoscopist, or
pathologist. An eccentrically placed gestational sac
causing this mass effect has been termed a
“cornual pregnancy.” Many clinicians and
radiologists use interstitial and cornual ectopic
pregnancy interchangeably.

What are the treatment options ?
How can a radiologist save the
situation?

• Treatment options for interstitial ectopic
pregnancy include local injection or
systemic therapy with methotrexate, local
injection of potassium chloride,
conservative laparoscopic surgery and
uterine artery embolism and in emergency
situations, cornuectomy or hysterectomy

Rastogi R, Gl M, Rastogi N, Rastogi V. Interstitial ectopic pregnancy: A rare and
difficult clinicosonographic diagnosis. J Hum Reprod Sci. 2008;1(2):81-82.
doi:10.4103/0974-1208.44116

• Transvaginal Aspiration of Ectopic Gestational
Sac , is a simple effective fertility preserving
minimally invasive option

Tuncay G, Karaer A, Coskun EI, Melekoglu R. Treatment of unruptured cornual
pregnancies by local injections of methotrexate or potassium chloride under
transvaginal ultrasonographic guidance. Pak J Med Sci. 2018;34(4):1010-1013.
doi:10.12669/pjms.344.14600

• Under general anaesthesia, a 18 gauge
aspiration needle was inserted into the lateral
fornix and passed through the myometrium
directly into the gestational sac under
Transvaginal guidance under sterile conditions
with injection of potassium chloride solution

Post Aspiration

• In a selected patient population,
most of the unruptured, live ectopic
pregnancies can be successfully
managed without surgical
intervention using Ultrasound-
guided aspiration and injection with
KCl or MTX

References:

1. Tuncay G, Karaer A, Coskun EI, Melekoglu R. Treatment of
unruptured cornual pregnancies by local injections of
methotrexate or potassium chloride under transvaginal
ultrasonographic guidance. Pak J Med Sci. 2018;34(4):1010-1013.
doi:10.12669/pjms.344.14600

2. LipscombGH, Stovall TG, Ling FW. Nonsurgical treatment of
ectopic pregnancy. N Engl J Med2000; 343: 1325–1329.

3. Baltarowich, O.H. (2017), The Term “Cornual Pregnancy” Should
Be Abandoned. J Ultrasound Med, 36: 1081-
1087. https://doi.org/10.1002/jum.14207

4. Diagnostic Clues to Ectopic Pregnancy -Radiographics
//doi.org/10.1148/rg.286085506

5. Rastogi R, Gl M, Rastogi N, Rastogi V. Interstitial ectopic
pregnancy: A rare and difficult clinicosonographic diagnosis. J Hum
Reprod Sci. 2008;1(2):81-82. doi:10.4103/0974-1208.44116