Ovarian pregnancy: an ultrasound challenge

Abstract

Ovarian pregnancy (OP) is rare: it accounts for 3.2% of ectopic pregnancies. We here report the case of a 36-year old patient gravida 3, para 2. The only risk factor for ectopic pregnancy found in this patient was a history of intrauterine contraceptive device (IUCD) use. Clinical symptoms were dominated by the occurrence of pelvic pain at 5-weeks of amenorrhoea. At the initial visit to the Emergency Department ß-Human chorionic gonadotropin (HCG) was 2134 IU/L. Preoperative diagnosis of ovarian pregnancy was suspected due to a rounded image measuring 26 mm with double echogenic crown visible on the left ovary without associated free fluid in the pouch of Douglas on ultrasound. Treatment was based on coelioscopy with resection of the ectopic chorionic villi in the left ovary. Medical treatment was based on intramuscular injection of methotrexate 1 mg/kg body weight in the immediate post-operative period because of the risk of a little residual of trophoblastic material. The diagnosis was confirmed by the histological study of the surgical specimen. The postoperative course was uneventful.