Ectopic pregnancy implanted in the liver under the diaphragm

Abstract

Abdominal pregnancy has been defined as an ectopic pregnancy implanted in the peritoneal cavity but excludes pregnancies that are tubal, ovarian, or intraligamentous [1]. Abdominal pregnancy is rarely seen and accounts for approximately 1% of all ectopic pregnancies [2]. Ordinarily, the location of an abdominal pregnancy is pelvic, but very rarely it may be implanted in the upper abdomen (especially on the liver) [3]. In most cases, the attachment site of the placenta is on the lower surface of the right lobe of the liver [2]. Here we report a case of ectopic pregnancy implanted on the upper surface of the right liver lobe. A 33-year-old Chinese woman (gravida 4, para 2) was admitted to our hospital’s emergency department with severe pain in the right upper quadrant of her abdomen and right shoulder pain radiation for a duration of 1 day. She had undergone two cesarean deliveries (the first in 2003 and the second 9 months prior to her presentation) and had not used any contraceptive method afterwards. On admission, she claimed to have amenorrhoea for 5 weeks and a urinary pregnancy test was weakly positive. Her serum hCG was elevated at 186.14 mIU/mL. On examination, her pulse was 82 beats/minute and blood pressure was 108/80 mmHg. Her physical examination was normal except for right upper quadrant tenderness. On vaginal examination, the uterus was normal in size with no definite adnexal mass. There was no vaginal bleeding. Transvaginal and transabdominal ultrasound examination showed a normal-sized uterus with an endometrial thickness of 8.4 mm, normal bilateral adnexae, and a moderate amount of free fluid in the abdomen. A mixed echogenic mass of 91 mm 37 mm in size was observed attached to the superior surface of the right liver lobe (Fig. 1). Because of this unusual finding, a computed tomography scan of the abdomen and pelvis was performed. A 90-mm-long mixed hypodense mass was evident on the upper surface of the right liver lobe (Fig. 2).