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Unusual Ectopic Pregnancies
Amelia Wnorowski, MD; Fauzia Vandermeer, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Interstitial ectopic pregnancy (EP): Pregnancy occurring in interstitial (intramural) portion of fallopian tube
              • Synonym: Intramural EP
              • Cornual pregnancy: Older term often used interchangeably with interstitial EP or to refer to pregnancy in cornua of abnormal uterus (horn of uni- or bicornuate uterus or lateral 1/2 of septate uterus); recent calls in literature to abandon this term to avoid confusion
            • Uterine scar EP: Pregnancy at site of previous uterine surgery, e.g., myomectomy or C-section
              • Synonyms: Scar EP, C-section scar EP
            • Cervical EP: Pregnancy in wall of cervix below level of internal cervical os
            • Ovarian EP: Intraovarian implantation
            • Abdominal EP: Implantation in peritoneal cavity
              • Primary: Direct peritoneal implantation; secondary (more common): Reimplantation of ruptured extrauterine pregnancy in peritoneal cavity
            • Heterotopic pregnancy: Concurrent intrauterine pregnancy & EP

          IMAGING

          • General Features

            • Ultrasonographic Findings

              • MR Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    CLINICAL ISSUES

                    • Presentation

                      • Demographics

                        • Natural History & Prognosis

                          • Treatment

                            DIAGNOSTIC CHECKLIST

                            • Consider

                              • Image Interpretation Pearls

                                Selected References

                                1. Jensen KK et al: Imaging of acute pelvic pain: pregnant (ectopic and first-trimester viability updated). Radiol Clin North Am. 58(2):347-61, 2020
                                2. Phillips CH et al: First-trimester emergencies: a radiologist's perspective. Emerg Radiol. 25(1):61-72, 2018
                                3. Ramanathan S et al: Magnetic resonance imaging of common, uncommon, and rare implantation sites in ectopic pregnancy. Abdom Radiol (NY). 43(12):3425-35, 2018
                                4. Baltarowich OH: The term "cornual pregnancy" should be abandoned. J Ultrasound Med. 36(6):1081-7, 2017
                                5. Mausner Geffen E et al: Pitfalls and tips in the diagnosis of ectopic pregnancy. Abdom Radiol (NY). 42(5):1524-42, 2017
                                6. Ghaneie A et al: Unusual ectopic pregnancies: sonographic findings and implications for management. J Ultrasound Med. 34(6):951-62, 2015
                                7. 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
                                8. Parker RA 3rd et al: MR imaging findings of ectopic pregnancy: a pictorial review. Radiographics. 32(5):1445-60; discussion 1460-2, 2012
                                9. Izquierdo LA et al: Three-dimensional transvaginal sonography of interstitial pregnancy. J Clin Ultrasound. 31(9):484-7, 2003
                                10. 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

                                        TERMINOLOGY

                                        • Definitions

                                          • Interstitial ectopic pregnancy (EP): Pregnancy occurring in interstitial (intramural) portion of fallopian tube
                                            • Synonym: Intramural EP
                                            • Cornual pregnancy: Older term often used interchangeably with interstitial EP or to refer to pregnancy in cornua of abnormal uterus (horn of uni- or bicornuate uterus or lateral 1/2 of septate uterus); recent calls in literature to abandon this term to avoid confusion
                                          • Uterine scar EP: Pregnancy at site of previous uterine surgery, e.g., myomectomy or C-section
                                            • Synonyms: Scar EP, C-section scar EP
                                          • Cervical EP: Pregnancy in wall of cervix below level of internal cervical os
                                          • Ovarian EP: Intraovarian implantation
                                          • Abdominal EP: Implantation in peritoneal cavity
                                            • Primary: Direct peritoneal implantation; secondary (more common): Reimplantation of ruptured extrauterine pregnancy in peritoneal cavity
                                          • Heterotopic pregnancy: Concurrent intrauterine pregnancy & EP

                                        IMAGING

                                        • General Features

                                          • Ultrasonographic Findings

                                            • MR Findings

                                              • Imaging Recommendations

                                                DIFFERENTIAL DIAGNOSIS

                                                  CLINICAL ISSUES

                                                  • Presentation

                                                    • Demographics

                                                      • Natural History & Prognosis

                                                        • Treatment

                                                          DIAGNOSTIC CHECKLIST

                                                          • Consider

                                                            • Image Interpretation Pearls

                                                              Selected References

                                                              1. Jensen KK et al: Imaging of acute pelvic pain: pregnant (ectopic and first-trimester viability updated). Radiol Clin North Am. 58(2):347-61, 2020
                                                              2. Phillips CH et al: First-trimester emergencies: a radiologist's perspective. Emerg Radiol. 25(1):61-72, 2018
                                                              3. Ramanathan S et al: Magnetic resonance imaging of common, uncommon, and rare implantation sites in ectopic pregnancy. Abdom Radiol (NY). 43(12):3425-35, 2018
                                                              4. Baltarowich OH: The term "cornual pregnancy" should be abandoned. J Ultrasound Med. 36(6):1081-7, 2017
                                                              5. Mausner Geffen E et al: Pitfalls and tips in the diagnosis of ectopic pregnancy. Abdom Radiol (NY). 42(5):1524-42, 2017
                                                              6. Ghaneie A et al: Unusual ectopic pregnancies: sonographic findings and implications for management. J Ultrasound Med. 34(6):951-62, 2015
                                                              7. 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
                                                              8. Parker RA 3rd et al: MR imaging findings of ectopic pregnancy: a pictorial review. Radiographics. 32(5):1445-60; discussion 1460-2, 2012
                                                              9. Izquierdo LA et al: Three-dimensional transvaginal sonography of interstitial pregnancy. J Clin Ultrasound. 31(9):484-7, 2003
                                                              10. Ackerman TE et al: Interstitial line: sonographic finding in interstitial (cornual) ectopic pregnancy. Radiology. 189(1):83-7, 1993