A live left tubal ectopic pregnancy is an extra-uterine pregnancy in which a fertilized egg has implanted in the left fallopian tube and fetal (embryonic) cardiac activity is demonstrable at the ectopic site on ultrasound.
⚙️ Technique ↑ Top
TVS Scanning Technique for Live Tubo-Ovarian Ectopic Pregnancy
1. Patient Preparation:
Bladder should be empty for optimal visualization. The patient is positioned in lithotomy or dorsal position. Use a high-frequency endovaginal probe (5–9 MHz) covered with a sterile sheath and coupling gel.
2. Initial Pelvic Survey:
Begin with a grayscale evaluation before applying Doppler. Examine the uterus, adnexa, and pouch of Douglas.
- Uterus: Assess size, shape, and endometrium; confirm absence of intrauterine gestational sac.
- Adnexa: Sweep laterally to locate ovaries and any adnexal mass separate from the uterus.
- Pouch of Douglas: Check for free or echogenic fluid suggestive of hemoperitoneum.
3. Identification of Tubal Ectopic:
Look for an adnexal gestational sac with an echogenic rim adjacent to or inseparable from the ovary. The presence of a yolk sac or fetal pole with cardiac activity confirms a live ectopic. Typical signs include:
- “Tubal Ring” sign: Echogenic ring around the sac separate from uterus.
- “Cogwheel” sign: Thickened tubular structure in chronic cases.
- Free fluid or clot in the cul-de-sac.
4. Color and Power Doppler Evaluation:
- “Ring of Fire” appearance showing high-velocity peripheral vascularity.
- Low-resistance, high-velocity flow (RI < 0.5).
- Central embryonic flow confirming fetal cardiac activity.
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๐️ Ultrasound Report Lines ↑ Top
The uterus is normal in size and shows an empty endometrial cavity with a thickened, decidualized endometrium. No intrauterine gestational sac is visualized.
A well-defined extrauterine gestational sac is seen in the left adnexa, separate from the ovary, showing a fetal pole with crown–rump length (CRL) measuring approximately ___ mm, corresponding to a gestational age of about ___ weeks ___ days.
Fetal cardiac activity is present with a heart rate of 147 beats per minute, confirming a live left tubal ectopic pregnancy.
Color Doppler demonstrates prominent peripheral vascularity (“ring of fire” sign) around the ectopic sac. The right ovary appears normal. Mild free fluid is noted in the pouch of Douglas.
Impression:
Live left tubal ectopic pregnancy with CRL measuring 10.56 mm (≈ 07 weeks 01 days) and fetal heart rate of 147 bpm.
Mild free fluid in the pouch of Douglas.
๐️ Ultrasound Features ↑ Top
Ultrasound Features – Live Left Tubal Ectopic Pregnancy
Grayscale Findings:
• Uterus is normal in size with an empty endometrial cavity showing decidual reaction.
• A well-defined extrauterine gestational sac is seen in the left adnexal region, separate from the ovary.
• The sac shows an echogenic wall (“tubal ring” sign).
• A fetal pole is visualized within the sac with measurable CRL corresponding to gestational age.
• Fetal cardiac activity is present (FHR: 147 bpm), confirming a live ectopic pregnancy.
• Left ovary is seen separately and appears normal.
• Mild free fluid noted in the pouch of Douglas.
Color & Doppler Findings:
• Prominent peripheral vascularity around the sac (“ring of fire” sign).
• Low-resistance, high-velocity trophoblastic flow pattern.
• Cardiac activity seen within fetal pole on color/M-mode Doppler.
Diagnostic Impression:
Findings are consistent with a live left tubal ectopic pregnancy with CRL measuring ___ mm (≈ ___ weeks ___ days) and fetal heart rate of 147 bpm.
Mild free fluid in pouch of Douglas.
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Prepared by: R. K. Mouj — Radio-imaging Technologist
Clinical Summary / Indication:
Female patient, reproductive age, presented with lower abdominal pain and vaginal spotting. Serum ฮฒ-hCG positive. Transvaginal sonography (TVS) requested to evaluate for possible ectopic pregnancy. Patient identifiers have been removed for confidentiality.
Ultrasound Findings:
Uterus: Normal in size; endometrial cavity empty with decidual reaction. No intrauterine gestational sac visualized.
Left adnexa: A well-defined extra-uterine gestational sac is demonstrated in the left adnexal region, separate from the left ovary. A fetal pole is visualized within the sac. Crown–rump length (CRL) measured approximately 10.5 mm.
Cardiac activity: Fetal cardiac activity present; fetal heart rate (FHR) measured at 147 beats per minute on M-mode. Color Doppler demonstrates prominent peripheral trophoblastic vascularity (“ring of fire”) surrounding the sac.
Cul-de-sac: Mild free fluid is present in the pouch of Douglas. Right adnexa and right ovary appear sonographically unremarkable.
Measurements:
CRL: 10.5 mm (corresponding to ≈ 7w + 1d by CRL reference charts).
FHR: 147 bpm.
Interpretation:
Findings are consistent with a live left tubal ectopic pregnancy — extrauterine gestational sac in the left adnexa with viable embryo (CRL 10.5 mm; FHR 147 bpm). Mild pelvic free fluid suggestive of minor bleeding/leakage. Correlate clinically and with serial ฮฒ-hCG. Given presence of embryonic cardiac activity, medical management with systemic methotrexate is generally contraindicated; urgent surgical consultation (gynaecology/obstetrics) is recommended for definitive management (laparoscopy/laparotomy) depending on clinical status.
Limitations:
Sonographic assessment is operator dependent. Exact site of tubal implantation (ampullary vs fimbrial) is approximated by ultrasound but may be confirmed at surgery. Hemodynamic status should guide immediate management; if signs of rupture or instability are present, expedite surgical intervention.
Ethics & Patient Data Statement:
Patient images and clinical details used for this report are anonymised. Use of any patient material conforms to institutional ethics guidelines and was included with appropriate consent or institutional approval. Identifiable patient information has been removed.
A live left tubal ectopic pregnancy is an extra-uterine pregnancy in which a fertilized egg has implanted in the left fallopian tube and fe...
