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Acute abdomen or life-threatening heterotopic pregnancy with tubal rupture: where does imaging play a role?
  1. Mark Kong1,
  2. Kethesparan Paramesparan2,
  3. Chhaya Keshvala2 and
  4. Amit Shah2
  1. 1University Hospitals of Leicester NHS Trust, Leicester, UK
  2. 2Radiology, University Hospitals of Leicester NHS Trust, Leicester, UK
  1. Correspondence to Dr Kethesparan Paramesparan; kethesparan{at}


Heterotopic pregnancy (HP) is a rare, potentially life-threatening complication of an intrauterine pregnancy with a simultaneous ectopic pregnancy. There is a higher incidence with assisted reproduction techniques (ART) and radiology can be pivotal in its diagnosis. A 28-year-old woman underwent ART and at 7 weeks’ gestation presented with acute right iliac fossa pain. Transvaginal ultrasound (US) imaging confirmed a viable intrauterine pregnancy. The patients’ pain persisted however, and transabdominal US demonstrated a complex, heterogeneous right adnexal mass. Subsequent magnetic resonance imaging (MRI) confirmed an HP with a ruptured ectopic and haemoperitoneum. Emergency laparoscopic surgery and right salpingo-oopherectomy were performed without complication. We highlight the importance of considering HP as a diagnosis in the acute gravid abdomen, especially when initial investigations have confirmed a viable intrauterine pregnancy. Furthermore, this case highlights MRI as a useful modality in complex cases due to its high soft tissue contrast resolution using non-ionising radiation.

  • emergency medicine
  • pregnancy
  • radiology
  • obstetrics and gynaecology

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  • Contributors MK obtained consent from the patient, reviewed case notes and obtained notes on surgical outcome and imaging. MK also wrote the first draft of the manuscript. Subsequent drafts were edited by CK and KP. The final draft was reviewed by AS. All authors contributed to and have approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.