Role of grey scale ultrasound and Colour Doppler findings to differentiate ectopic pregnancy from corpus luteum cyst of pregnancy
Abstract
Introduction: Ectopic pregnancy and corpus luteum cyst are two most common differential diagnosis in a patient with UPT positive and no sonographic evidence of intrauterine pregnancy.
Aim: To diagnose ectopic pregnancy and to differentiate ectopic pregnancy from corpus luteum cyst of pregnancy on the basis of grey scale ultrasound and colour Doppler findings.
Material and Methods: This was a hospital based prospective study carried out on a study group of 40 patients with UPT positive and clinical features suggestive of ectopic pregnancy over a period of two years.Grey scale ultrasound and colour Doppler parameters were studied.
Results: Out of 40 patients,30 were diagnosed with ectopic pregnancy and 10 with corpus luteum cyst. Ectopic pregnancies had thicker walls as compared to corpus luteum cysts. Most of the ectopic pregnancies had hyperechoic walls as compared to ovaries (80%) and endometrium (60%). Free fluid with echoes was seen in the pelvis in 70% ectopic pregnancies whereas most of the corpus luteum cysts (80%) had no free fluid. Most of the corpus luteum cysts (70%) had clear internal echotexture whereas ectopic pregnancies were mostly lacy or solid.Yolk sac was seen exclusively in ectopic pregnancy (30%). RI <0.4 and RI >0.7 was found to be highly specific for diagnosing ectopic pregnancy.
Conclusion: Wall thickness of the mass, echogenicity of the wall as compared to ovaryand endometrium, internal echotexture of the cystic mass, presence of yolk sac and presence of free fluid with echoes are significant ultrasound parameters which help to differentiate between the two. RI <0.4 and RI >0.7 was found to be highly specific for diagnosing ectopic pregnancy.
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References
Schneider J, Berger CJ, Cattell C. Maternal mortality due to ectopic pregnancy. A review of 102 deaths. Obstet Gynecol. 1977 May;49(5):557-61.
Moini A, Hosseini R, Jahangiri N, et al. Risk factors for ectopic pregnancy: A case-control study. J Res Med Sci. 2014 Sep;19(9):844-9.
Chanana C, Gupta N, Bansal I, Hooda K, Sharma P, Gupta M et al. Different Sonographic Faces of Ectopic Pregnancy. J Clin Imaging Sci. 2017;7:6.
Stein MW, Ricci ZJ, Novak L, et al. Sonographic comparison of the tubal ring of ectopic pregnancy with the corpus luteum. J Ultrasound Med. 2004 Jan;23(1):57-62.
Atri M. Ectopic pregnancy versus corpus luteum cyst revisited: best Doppler predictors. J Ultrasound Med. 2003 Nov;22(11):1181-4.
Blaivas M, Lyon M. Reliability of adnexal mass mobility in distinguishing possible ectopic pregnancy from corpus luteum cysts. J Ultrasound Med. 2005 May;24(5):599-603; quiz 605.
Rottem S, Thaler I, Levron J, et al. Criteria for transvaginal sonographic diagnosis of ectopic pregnancy. J Clin Ultrasound. 1990 May;18(4):274-9.
Algazzar HY, Ghandour AM, Aboueldahab AF, Mohamed AH. Tubal ring sign of ectopic pregnancy versus corpus luteum cyst: best sonographic and color duplex predictors. The Egyptian J Radiology and Nuclear Med. 2005:1-7.
Frates MC, Visweswaran A, Laing FC. Comparison of tubal ring and corpus luteum echogenicities: a useful differentiating characteristic. J Ultrasound Med. 2001 Jan;20(1):27-31; quiz 33.
Frates MC, Doubilet PM, Peters HE, et al. Adnexal sonographic findings in ectopic pregnancy and their correlation with tubal rupture and human chorionic gonadotropin levels. J Ultrasound Med. 2014 Apr;33(4):697-703. doi: https://doi.org/10.7863/ultra.33.4.697.
Frates MC, Laing FC. Sonographic evaluation of ectopic pregnancy: an update. AJR Am J Roentgenol. 1995 Aug;165(2):251-9.
Chen PC, Sickler GK, Dubinsky TJ, et al. Sonographic detection of echogenic fluid and correlation with culdocentesis in the evaluation of ectopic pregnancy. AJR Am J Roentgenol. 1998 May;170(5):1299-302.DOI: https://doi.org/10.2214/ajr.170.5.9574606.
Fauconnier A, Mabrouk A, Salomon LJ, et al. Ultrasound assessment of haemoperitoneum in ectopic pregnancy: derivation of a prediction model. World J Emerg Surg. 2007 Sep 7;2:23. DOI: https://doi.org/10.1186/1749-7922-2-23.
Fukami T, Emoto M, Tamura R, et al. Sonographic findings of transvaginal color Doppler ultrasound in ectopic pregnancy. J Med Ultrason (2001). 2006 Mar;33(1):37-42. doi: https://doi.org/10.1007/s10396-005-0064-9.
Salim A, Zalud I, Farmakides G, et al. Corpus luteum blood flow in normal and abnormal early pregnancy: evaluation with transvaginal color and pulsed Doppler sonography. J Ultrasound Med. 1994 Dec;13(12):971-5.
Kurjak A, Zalud I, Schulman H. Ectopic pregnancy: transvaginal color Doppler of trophoblastic flow in questionable adnexa. J Ultrasound Med. 1991 Dec;10(12):685-9.
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