#WetreadCoW Case 15
Hx: Vaginal bleeding
What is the first question to ask? What are the possible diagnoses? (more images to come of course 😀)
Professionally appropriate gif responses only please. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #bodyrad
Hx: Vaginal bleeding
What is the first question to ask? What are the possible diagnoses? (more images to come of course 😀)
Professionally appropriate gif responses only please. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #bodyrad
@ER_Rad_Hanna @GayatriJoshiMD @RadioGyan #WetreadCoW Case 15 (cont)
+Urine pregnancy test
Diagnosis(es)? Gifs only please! 😀 FOAMrad #FOAMed #radres #errad #bodyrad
+Urine pregnancy test
Diagnosis(es)? Gifs only please! 😀 FOAMrad #FOAMed #radres #errad #bodyrad
#WetreadCoW Answer: Cervical Ectopic Pregnancy
Imaging is easy!
-⭐️NO IUP(endometrium opposed, no fluid or sac)
-gestation sac w/ fetal pole in cervix
Options:
1) cervical ectopic
2) spont abortion
Here: Closed os, no endometrial fluid➡️ectopic
#FOAMrad #bodyrad #errad #obgyn
Imaging is easy!
-⭐️NO IUP(endometrium opposed, no fluid or sac)
-gestation sac w/ fetal pole in cervix
Options:
1) cervical ectopic
2) spont abortion
Here: Closed os, no endometrial fluid➡️ectopic
#FOAMrad #bodyrad #errad #obgyn
Ectopic W/U #radres
⭐️⭐️ALWAYS ✅pregnancy status in ANY ♀️ that COULD be pregnant.
⭐️Ectopic is often dx of exclusion!
+Pregnancy test
#1 IUP? Yes=Done No=too early, spont AB or ectopic
#2 bHCG? descrim level=3500*. >3500 =not too early
#3 bHCG trend? ⬇️=AB, ➡️/⬆️ = ectopic
⭐️⭐️ALWAYS ✅pregnancy status in ANY ♀️ that COULD be pregnant.
⭐️Ectopic is often dx of exclusion!
+Pregnancy test
#1 IUP? Yes=Done No=too early, spont AB or ectopic
#2 bHCG? descrim level=3500*. >3500 =not too early
#3 bHCG trend? ⬇️=AB, ➡️/⬆️ = ectopic
*Some may ask bHCG of 3500?
2018 ACOG Practice bulletin rec raising descriminatory level to 3500 for a single quant bHCG when utilized with a transVAGINAL US in order to minimize the risk of overtreating o/w nl early IUPs with mtx. #FOAMed #radres #obgyn journals.lww.com/greenjournal/F…
2018 ACOG Practice bulletin rec raising descriminatory level to 3500 for a single quant bHCG when utilized with a transVAGINAL US in order to minimize the risk of overtreating o/w nl early IUPs with mtx. #FOAMed #radres #obgyn journals.lww.com/greenjournal/F…
Ectopic Pregnancy
-can be ANYWHERE but ~95% tubal (m/c ampulla)
-3% cornual/interstitial - present late ⬆️ risk of bleed
-~1% ovarian
-<1% cervical
-<1% "scar" (site of prior C-section)
-1% abdominal
Risks: IVF, altered anatomy (h/o PID, IUD, tubal ligation, etc), maternal age
-can be ANYWHERE but ~95% tubal (m/c ampulla)
-3% cornual/interstitial - present late ⬆️ risk of bleed
-~1% ovarian
-<1% cervical
-<1% "scar" (site of prior C-section)
-1% abdominal
Risks: IVF, altered anatomy (h/o PID, IUD, tubal ligation, etc), maternal age
#Radres Ectopics
⭐️empty uterus
-live extra-uterine gestation😁(rare)
-often see NOTHING
-⭐️complex mass adj to ovary(can resemble corpus luteum but CL is IN the ovary)
-tubal ring about sac
-Doppler ring of fire -seen with CL as well!
-endometrial fluid ie pseudogestational sac
⭐️empty uterus
-live extra-uterine gestation😁(rare)
-often see NOTHING
-⭐️complex mass adj to ovary(can resemble corpus luteum but CL is IN the ovary)
-tubal ring about sac
-Doppler ring of fire -seen with CL as well!
-endometrial fluid ie pseudogestational sac
Cervical Ectopic Trt
-IM mtx limited effect
-❌DNC❌ due to ⬆️risk of severe hemorrhage
-Intrasac mtx or KCL (if +hr)
-IR uterine artery embo
-hysterectomy
-IM mtx limited effect
-❌DNC❌ due to ⬆️risk of severe hemorrhage
-Intrasac mtx or KCL (if +hr)
-IR uterine artery embo
-hysterectomy
@threadreaderapp unroll
• • •
Missing some Tweet in this thread? You can try to
force a refresh
