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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Definitions
Terminology in literature is confusing and inconsistently applied
Interstitial ectopic pregnancy is preferred term
Blastocyst implants in interstitial portion of fallopian tube
Intramural ectopic pregnancy
Descriptively correct as interstitial portion of fallopian tube does transverse uterine wall but not technically accurate as blastocyst implants in tube not myometrium
Angular pregnancy
Pregnancy implanted at lateral angle of uterine cavity medial to uterotubal junction
Located medial to round ligament
Cornual pregnancy often used interchangeably with interstitial ectopic, but there is great ambiguity
Some authors use term for any pregnancy in cornual region, which overlaps with angular pregnancy
Others use cornual to refer to pregnancy in 1 horn of duplication anomaly (septate or bicornuate uterus)
Recent literature recommends this term be dropped
IMAGING
General Features
Ultrasonographic Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Chukus A et al: Uncommon implantation sites of ectopic pregnancy: thinking beyond the complex adnexal mass. Radiographics. 35(3):946-59, 2015
Tanaka K et al: Management of interstitial ectopic pregnancy with intravenous methotrexate: An extended study of a standardised regimen. Aust N Z J Obstet Gynaecol. 55(2):176-80, 2015
Arleo EK et al: Cornual, interstitial, and angular pregnancies: clarifying the terms and a review of the literature. Clin Imaging. 38(6):763-70, 2014
Hiersch L et al: Effectiveness of medical treatment with methotrexate for interstitial pregnancy. Aust N Z J Obstet Gynaecol. 54(6):576-80, 2014
Nezhat CH et al: Laparoscopically-assisted, hysteroscopic removal of an interstitial pregnancy with a fertility-preserving technique. J Minim Invasive Gynecol. 21(6):1091-4, 2014
Pedroso C et al: Interstitial pregnancy rupture at 15 weeks of pregnancy. BMJ Case Rep. 2014, 2014
Tanaka Y et al: Three-dimensional sonography in the differential diagnosis of interstitial, angular, and intrauterine pregnancies in a septate uterus. J Ultrasound Med. 33(11):2031-5, 2014
Rheinboldt M et al: Atypical presentation of a large interstitial pregnancy. Emerg Radiol. 20(3):251-4, 2013
Sagiv R et al: Interstitial pregnancy management and subsequent pregnancy outcome. Acta Obstet Gynecol Scand. 92(11):1327-30, 2013
Cucinella G et al: Laparoscopic management of interstitial pregnancy: the "purse-string" technique. Acta Obstet Gynecol Scand. 91(8):996-9, 2012
Tamarit G et al: Combined use of uterine artery embolization and local methotrexate injection in interstitial ectopic pregnancies with poor prognosis. Fertil Steril. 93(4):1348, 2010
Moon HS et al: The outcomes of pregnancy following laparoscopic cornuotomy for interstitial pregnancy. Fertil Steril. 92(2):e24; author reply e25, 2009
Takeda A et al: Successful management of interstitial pregnancy with fetal cardiac activity by laparoscopic-assisted cornual resection with preoperative transcatheter uterine artery embolization. Arch Gynecol Obstet. 280(2):305-8, 2009
Lin EP et al: Diagnostic clues to ectopic pregnancy. Radiographics. 28(6):1661-71, 2008
Valsky DV et al: Ectopic pregnancies of unusual location: management dilemmas. Ultrasound Obstet Gynecol. 31(3):245-51, 2008
Araujo Júnior E et al: Three-dimensional transvaginal sonographic diagnosis of early and asymptomatic interstitial pregnancy. Arch Gynecol Obstet. 275(3):207-10, 2007
Mavrelos D et al: Ultrasound diagnosis of ectopic pregnancy in the non-communicating horn of a unicornuate uterus (cornual pregnancy). Ultrasound Obstet Gynecol. 30(5):765-70, 2007
Deruelle P et al: Management of interstitial pregnancy using selective uterine artery embolization. Obstet Gynecol. 107(2 Pt 1):427-8, 2006
Klemm P et al: Sonographic monitoring of systemic and local methotrexate (MTX) therapy in patients with intact interstitial pregnancies. J Perinat Med. 34(2):149-57, 2006
Tang A et al: A medical management of interstitial ectopic pregnancy: a 5-year clinical study. Aust N Z J Obstet Gynaecol. 46(2):107-11, 2006
Cassik P et al: Factors influencing the success of conservative treatment of interstitial pregnancy. Ultrasound Obstet Gynecol. 26(3):279-82, 2005
Deruelle P et al: Management of interstitial pregnancy using selective uterine artery embolization. Obstet Gynecol. 106(5 Pt 2):1165-7, 2005
Filhastre M et al: Interstitial pregnancy: role of MRI. Eur Radiol. 15(1):93-5, 2005
Lee GS et al: Diagnosis of early intramural ectopic pregnancy. J Clin Ultrasound. 33(4):190-2, 2005
Coric M et al: Laparoscopic approach to interstitial pregnancy. Arch Gynecol Obstet. 270(4):287-9, 2004
Jermy K et al: The conservative management of interstitial pregnancy. BJOG. 111(11):1283-8, 2004
Tarim E et al: Angular pregnancy. J Obstet Gynaecol Res. 30(5):377-9, 2004
Tulandi T et al: Interstitial pregnancy: results generated from the Society of Reproductive Surgeons Registry. Obstet Gynecol. 103(1):47-50, 2004
Akrivis Ch et al: Early ultrasonographic diagnosis of unruptured interstitial pregnancy: a case report and review of the literature. Clin Exp Obstet Gynecol. 30(1):60-4, 2003
Chan LY et al: Pitfalls in diagnosis of interstitial pregnancy. Acta Obstet Gynecol Scand. 82(9):867-70, 2003
Izquierdo LA et al: Three-dimensional transvaginal sonography of interstitial pregnancy. J Clin Ultrasound. 31(9):484-7, 2003
Bouyer J et al: Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod. 17(12):3224-30, 2002
Chen CL et al: Successful conservative treatment for advanced interstitial pregnancy. A case report. J Reprod Med. 47(5):424-6, 2002
Ackerman TE et al: Interstitial line: sonographic finding in interstitial (cornual) ectopic pregnancy. Radiology. 189(1):83-7, 1993
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Definitions
Terminology in literature is confusing and inconsistently applied
Interstitial ectopic pregnancy is preferred term
Blastocyst implants in interstitial portion of fallopian tube
Intramural ectopic pregnancy
Descriptively correct as interstitial portion of fallopian tube does transverse uterine wall but not technically accurate as blastocyst implants in tube not myometrium
Angular pregnancy
Pregnancy implanted at lateral angle of uterine cavity medial to uterotubal junction
Located medial to round ligament
Cornual pregnancy often used interchangeably with interstitial ectopic, but there is great ambiguity
Some authors use term for any pregnancy in cornual region, which overlaps with angular pregnancy
Others use cornual to refer to pregnancy in 1 horn of duplication anomaly (septate or bicornuate uterus)
Recent literature recommends this term be dropped
IMAGING
General Features
Ultrasonographic Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Chukus A et al: Uncommon implantation sites of ectopic pregnancy: thinking beyond the complex adnexal mass. Radiographics. 35(3):946-59, 2015
Tanaka K et al: Management of interstitial ectopic pregnancy with intravenous methotrexate: An extended study of a standardised regimen. Aust N Z J Obstet Gynaecol. 55(2):176-80, 2015
Arleo EK et al: Cornual, interstitial, and angular pregnancies: clarifying the terms and a review of the literature. Clin Imaging. 38(6):763-70, 2014
Hiersch L et al: Effectiveness of medical treatment with methotrexate for interstitial pregnancy. Aust N Z J Obstet Gynaecol. 54(6):576-80, 2014
Nezhat CH et al: Laparoscopically-assisted, hysteroscopic removal of an interstitial pregnancy with a fertility-preserving technique. J Minim Invasive Gynecol. 21(6):1091-4, 2014
Pedroso C et al: Interstitial pregnancy rupture at 15 weeks of pregnancy. BMJ Case Rep. 2014, 2014
Tanaka Y et al: Three-dimensional sonography in the differential diagnosis of interstitial, angular, and intrauterine pregnancies in a septate uterus. J Ultrasound Med. 33(11):2031-5, 2014
Rheinboldt M et al: Atypical presentation of a large interstitial pregnancy. Emerg Radiol. 20(3):251-4, 2013
Sagiv R et al: Interstitial pregnancy management and subsequent pregnancy outcome. Acta Obstet Gynecol Scand. 92(11):1327-30, 2013
Cucinella G et al: Laparoscopic management of interstitial pregnancy: the "purse-string" technique. Acta Obstet Gynecol Scand. 91(8):996-9, 2012
Tamarit G et al: Combined use of uterine artery embolization and local methotrexate injection in interstitial ectopic pregnancies with poor prognosis. Fertil Steril. 93(4):1348, 2010
Moon HS et al: The outcomes of pregnancy following laparoscopic cornuotomy for interstitial pregnancy. Fertil Steril. 92(2):e24; author reply e25, 2009
Takeda A et al: Successful management of interstitial pregnancy with fetal cardiac activity by laparoscopic-assisted cornual resection with preoperative transcatheter uterine artery embolization. Arch Gynecol Obstet. 280(2):305-8, 2009
Lin EP et al: Diagnostic clues to ectopic pregnancy. Radiographics. 28(6):1661-71, 2008
Valsky DV et al: Ectopic pregnancies of unusual location: management dilemmas. Ultrasound Obstet Gynecol. 31(3):245-51, 2008
Araujo Júnior E et al: Three-dimensional transvaginal sonographic diagnosis of early and asymptomatic interstitial pregnancy. Arch Gynecol Obstet. 275(3):207-10, 2007
Mavrelos D et al: Ultrasound diagnosis of ectopic pregnancy in the non-communicating horn of a unicornuate uterus (cornual pregnancy). Ultrasound Obstet Gynecol. 30(5):765-70, 2007
Deruelle P et al: Management of interstitial pregnancy using selective uterine artery embolization. Obstet Gynecol. 107(2 Pt 1):427-8, 2006
Klemm P et al: Sonographic monitoring of systemic and local methotrexate (MTX) therapy in patients with intact interstitial pregnancies. J Perinat Med. 34(2):149-57, 2006
Tang A et al: A medical management of interstitial ectopic pregnancy: a 5-year clinical study. Aust N Z J Obstet Gynaecol. 46(2):107-11, 2006
Cassik P et al: Factors influencing the success of conservative treatment of interstitial pregnancy. Ultrasound Obstet Gynecol. 26(3):279-82, 2005
Deruelle P et al: Management of interstitial pregnancy using selective uterine artery embolization. Obstet Gynecol. 106(5 Pt 2):1165-7, 2005
Filhastre M et al: Interstitial pregnancy: role of MRI. Eur Radiol. 15(1):93-5, 2005
Lee GS et al: Diagnosis of early intramural ectopic pregnancy. J Clin Ultrasound. 33(4):190-2, 2005
Coric M et al: Laparoscopic approach to interstitial pregnancy. Arch Gynecol Obstet. 270(4):287-9, 2004
Jermy K et al: The conservative management of interstitial pregnancy. BJOG. 111(11):1283-8, 2004
Tarim E et al: Angular pregnancy. J Obstet Gynaecol Res. 30(5):377-9, 2004
Tulandi T et al: Interstitial pregnancy: results generated from the Society of Reproductive Surgeons Registry. Obstet Gynecol. 103(1):47-50, 2004
Akrivis Ch et al: Early ultrasonographic diagnosis of unruptured interstitial pregnancy: a case report and review of the literature. Clin Exp Obstet Gynecol. 30(1):60-4, 2003
Chan LY et al: Pitfalls in diagnosis of interstitial pregnancy. Acta Obstet Gynecol Scand. 82(9):867-70, 2003
Izquierdo LA et al: Three-dimensional transvaginal sonography of interstitial pregnancy. J Clin Ultrasound. 31(9):484-7, 2003
Bouyer J et al: Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod. 17(12):3224-30, 2002
Chen CL et al: Successful conservative treatment for advanced interstitial pregnancy. A case report. J Reprod Med. 47(5):424-6, 2002
Ackerman TE et al: Interstitial line: sonographic finding in interstitial (cornual) ectopic pregnancy. Radiology. 189(1):83-7, 1993
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