PMC3753733_01
Utilizing a 5-8 MHz Sonosite intracavitary transducer, an empty uterus is noted. Posterior to the uterus, there is a region of hypoechoic fluid visualized (arrowheads).
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fig1
Focused, screening bedside transabdominal ultrasound followed by transvaginal ultrasound examination to evaluate for IUP performed by the treating EP revealed free fluid in the abdomen and the absence of a gestational sac in the uterus (Figure 1).
PMC3753733_02
Utilizing a Sonosite C60 2-5 MHz curvilinear transducer, this transabdominal ultrasound image displays an empty uterus with a thin sliver of hypoechoic fluid posterior to the uterine wall (arrow).
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fig2
Following patient discharge, free intraperitoneal fluid in the cul de sac was identified on routine ED ultrasound quality improvement review (Figures 2 and 3).
Pelvic ultrasound demonstrates the same hypoechoic fluid collection posterior to the uterine wall seen on transabdominal ultrasound in Figure 2.
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fig3
Following patient discharge, free intraperitoneal fluid in the cul de sac was identified on routine ED ultrasound quality improvement review (Figures 2 and 3).
PMC3753733_03
Pelvic ultrasound (long view, right adnexa) demonstrates a fluid collection of mixed echogenic and anechoic material surrounding the right ovary.
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fig4
The radiologist determined that there was an abnormal fluid collection around the right ovary most consistent with a hematoma (Figure 4).
Pelvic ultrasound demonstrates a right adnexal mass (labeled RT ADN) adjacent to the uterus (labeled UT) with surrounding hypoechoic fluid suspicious for ectopic pregnancy.
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fig5
The betahCG level had risen to 455 IU/L, and transvaginal ultrasound (bedside and in the radiology suite) performed during the repeat visit confirmed a right-sided ectopic pregnancy with associated free intraperitoneal fluid (Figure 5).