I scanned a young lady this week who presented with mild pain, no bleeding, positive hcg. Transvaginal ultrasound was performed; the uterus was empty and I noted moderate anterior and posterior cul-de-sac fluid.
The right adnexa was very heterogeneous with masses of different textures and free fluid. I also noted a two centimeter cyst on the right ovary, which I thought was probably the corpus luteum. Transabdominally, I could see a large mass in the right adnexa slightly anterior to the uterus.
After informing the doctor, we performed a colpocentesis (which was the first time I had seen this done). Sure enough, the pelvis was full of blood. We sent her to the ER where surgery confirmed the ectopic, however it was on the left side! I was very surprised since I had seen a 4 cm mass in the right adnexa. This area turned out to be a large blood clot. My mistake here was seeing the mass on the right and only briefly exploring the left, assuming the right would be the side of the ectopic. In the future I will be sure to adequately explore both adnexas!
