UMEM Educational Pearls

Category: Visual Diagnosis

Title: What's the daignosis? Written by Adam Brenner, MD

Keywords: ultrasound, ectopic, free fluid, hypotension, pregnancy (PubMed Search)

Posted: 2/27/2011 by Haney Mallemat, MD (Emailed: 2/28/2011) (Updated: 8/28/2014)
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24 yo woman presents with syncope, abdominal pain, and normal menses 4 days prior. Urine HCG(+) and quantitative beta-HCG is 1300 with the transvaginal ultrasound seen below. Diagnosis?


Ectopic Pregnancy Pearls

  1. Considering the history above, transvaginal ultrasound should be performed regardless of quantitative beta-HCG; even if below the discriminatory zone (<1500-1800)
  2. Transvaginal ultrasound suggests ectopic pregnancy (as in the case above), with an empty uterus and free pelvic fluid (Figure 1).
  3. The above history plus free abdominal fluid on FAST exam also suggests the diagnosis and should expedite management (Figure 2). 
  4. Please remember that ~15% of ectopic pregnancies present with normal menses.



Tintinalli, Judith, et al.  Tintinalli’s Emergency Medicine:  A Comprehensive Study Guide, 7th Edition.  2011, McGraw-Hill Companies, Inc, China