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Case Reports
. 2023 May 19;18(7):2531-2544.
doi: 10.1016/j.radcr.2023.04.028. eCollection 2023 Jul.

Distinguishing between cornual, angular and interstitial ectopic pregnancy: A case report and a brief literature review

Gurinder Dhanju  1   2 , Ashraf Goubran  2 , Lukasz Zimolag  2 , Robyn Chartrand  2 , Frankel Matthew  2 , Alli Breddam  2
Affiliations
Case Reports

Distinguishing between cornual, angular and interstitial ectopic pregnancy: A case report and a brief literature review

Gurinder Dhanju et al. Radiol Case Rep. .

Abstract

For all clinical purposes, cornual, angular, and interstitial pregnancies are considered ectopic pregnancies that can have grave consequences for the patient. In this article, we describe and distinguish 3 types of ectopic pregnancies in the cornual region of the uterus. The authors advocate using the "cornual pregnancy" term only for ectopic pregnancies in malformed uteruses. We describe an ectopic pregnancy in a 25-year-old G2P1 patient in the cornual region of the uterus that was missed twice sonographically in the second trimester and had almost fatal consequences in the patient. Radiologists and sonographers should be aware of the sonographic diagnosis of angular, cornual and interstitial pregnancies. Whenever possible, first-trimester transvaginal ultrasound scanning is crucial for diagnosing these 3 types of ectopic pregnancies in the cornual region. In the second and third trimesters, ultrasound tends to become equivocal; hence alternate imaging, such as MRI, might add additional value to the management of the patient. A case report assessment and a comprehensive literature review comprising 61 case reports of ectopic pregnancy in the second and third trimesters are diligently undertaken in the Medline, Embase and Web of Science databases. The major strength of our study is that it is one of the few studies that describe a literature review of ectopic pregnancy in the cornual region exclusively in the second and third trimesters.

Keywords: Angular; Cornual; Endometrium; Interstitial; Uterine malformation.

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Figures

Fig 1
Fig. 1
(A) Sagittal: Visualization of the cervical canal was difficult because the large size of the extrauterine pregnancy was displacing the cervix/uterus posteriorly and to the right. (B) Sagittal: A rough estimate for the potential distance from the lower edge of the placenta to the internal os was attempted. (C). Sagittal: Colour Doppler showing retroplacental flow extending to an area of myometrium near the suspected cervix.
Fig 2
Fig. 2
(A) Normal fetal development at 17 weeks. (B) Normal fetal heart rate. (C) Transverse: Echogenic FF in RLQ (arrow). (D) Sagittal: Echogenic FF in RLQ (arrow).
Fig 3
Fig. 3
(A) Transabdominal sagittal plane: A presumed uterus is seen in the right adnexal region. Arrowhead denotes a potential endometrial stripe. (Supplementary Video 2Fig. 3A). (B) Sagittal: Transvaginal ultrasound confirmed the uterus in the right adnexa. (C) Endovaginal transverse plane: The arrowhead depicts an empty left lateral endometrial region. (Supplementary Video 3Fig. 3C). (D). Sagittal: Transvaginal image of the cervix & uterine body. The arrowheads show communication of the cervix with the uterine cavity. (Supplementary Video 4Fig. 3D).
Fig 4
Fig. 4
(A). Sagittal: Free fluid in the hepatorenal recess. (B) Sagittal: Free fluid in the splenorenal recess.
Fig 5
Fig. 5
(A) Sagittal Normal contour of the uterine fundus and body. (B) Transverse Normal contour of endometrium & fundus (arrows).
See this image and copyright information in PMC

References

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