Ectopic Pregnancy Complicated by an Arteriovenous Malformation of the Fallopian Tube

Abstract

Ectopic pregnancy is still correlated with a high incidence of morbidity and mortality. 1 Increasing occurrences of sexually transmitted diseases (gonorrhea and chlamydia), pelvic inflammatory diseases, previous abortions, bitubal ligations, intrauterine devices, assisted reproductive techniques, late primiparity, and previous surgery are associated with chronic salpingitis, which is the most common finding associated with and responsible for ectopic pregnancy. 2 Improvements in the resolution of high-frequency transvaginal sonography have contributed greatly to the diagnosis of ectopic pregnancy, which has already been correlated with the β-human chorionic gonadotropin (β-hCG) level. 3,4 The introduction of 2-dimensional (2D) transvaginal scanning, color Doppler imaging, and nowadays, 3-dimensional (3D) transvaginal sonography can provide information about the location and size of the ectopic mass and impairment of the tube. Evaluation of these factors is important for selecting the best treatment for the patient and choosing among the different therapeutic possibilities (laparoscopy, methotrexate administration, and expectant management). Arteriovenous malformations (AVMs) in the female genital tract are relatively uncommon lesions in which there is direct communication between arterioles and venules. They can be either congenital or acquired. The association between ectopic pregnancy and AVMs is extremely rare; indeed, in the literature we found just 2 cases of ectopic pregnancy associated with an AVM. 5,6 We report a case of an ectopic pregnancy complicated by an AVM in which 2D transvaginal sonography, color Doppler imaging, pulsed wave Doppler imaging, and new 3D modes, including tomographic ultrasound imaging, the glass body mode, and 3D bidirectional power Doppler (HD-Flow) imaging, indicated the diagnosis and the best surgical plan.