MRI findings in ruptured ovarian ectopic pregnancy: an unexplored avenue


  • Annu Singhal Department of Radiodiagnosis, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
  • Vivek C. Kottiyath Department of Radiodiagnosis, Sky Dianostics, Uttam Nagar, Delhi, India
  • Tej Prakash Gupta Department of Radiodiagnosis, Saral Diagnostics, Saraswati Vihar, Delhi, India
  • Prachi Arora Department of Gynaecology and Obstetrics, Bhagwan Mahavir Hospital, Rani Bagh, Delhi, India



OEP, EP, TVS, Magnetic resonance imaging, Gestation sac, POD, Beta-human chorionic gonadotropin


Ovarian ectopic pregnancy (OEP) is a rare form of ectopic pregnancy (EP) and constitutes approximately 0.5-3% of all ectopic cases. Its presentation mimics the symptoms of tubal ectopic pregnancy, hemorrhagic ovarian cyst/follicle, tubo-ovarian abscess, urinary tract calculi, appendicitis or ovarian torsion. Occasionally determining the anatomic location of an extra-tubal ectopic pregnancy based on ultrasound imaging and presentation alone can be challenging, particularly when it is adherent to the fallopian tube. Although transvaginal ultrasound (TVS) is the primary modality used in the diagnosis, various forms of OEP and its complications may be incidentally detected and further evaluated on computed tomography (CT) or magnetic resonance imaging (MRI) when an alternative diagnosis is suspected. We reported a case of a second gravid para zero, 25 years old lady, who came with pain in the left lower abdomen. Her urine pregnancy test was positive. TVS showed empty uterine cavity, an extremely tender, heterogenous hyperechoic right adnexal mass, but no obvious gestation sac (GS). A large hematoma was detected adjacent to it in the pouch of Douglas (POD). Keeping a high suspicion of ectopic pregnancy, MRI was performed to evaluate the lesion better which revealed a natural, non-assisted, ruptured right ovarian ectopic pregnancy and was subsequently confirmed at laparotomy and proven on histopathology. Patient underwent left oophorectomy and discharged on 4th day with uneventful follow up.


Author Biography

Annu Singhal, Department of Radiodiagnosis, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India

Department of Radiodiagnosis, Associate Professor


Tehrani HG, Hamoush Z, Ghasemi M, Hashemi L. Ovarian ectopic pregnancy: a rare case. Iran J Reprod Med. 2014;12(4):281-4.

Choi HJ, Im KS, Jung HJ, Lim KT, Mok JE, Kwon YS. Clinical analysis of ovarian pregnancy: a report of 49 cases. Eur J Obstet Gynecol Reprod Biol. 2011;158(1):87-9.

Rathore R, Bansal R, Sharma R, Jindal R, Nargotra N. Ovarian ectopic pregnancy-a report of 2 cases and review of literature. Asian Pac J Health Sci. 2017;4(2):110-4.

Singh N, Sarmalkar M, Mehendale M, Nayak A. Ruptured primary ovarian ectopic pregnancy: a case series. Int J Reprod Contracept Obstet Gynaecol. 2016;5(10):3641-4.

Stein MW, Ricci ZJ, Novak L, Roberts JH, Koenigsberg M. Sonographic comparison of the tubal ring of ectopic pregnancy with the corpus luteum. J Ultrasound Med. 2004;23(1):57-62.

Tamai K, Koyama T, Togashi K. MR features of ectopic pregnancy. Eur Radiol. 2007;17(12):3236-46.

Borrelli PT, Butler SA, Docherty SM, Staite EM, Borrelli AL, Iles RK. Human chorionic gonadotropin isoforms in the diagnosis of ectopic pregnancy. Clin Chem. 2003;49(12):2045-9.

Roy J, Babu AS. Ovarian pregnancy: two case reports. Australas Med J. 2013;6(8):406-10.

Takahashi A, Takahama J, Marugami N. Ectopic pregnancy: MRI findings and clinical utility. Abdomin Imaging. 2013;38(4):844-50.

Io S, Hasegawa M, Koyama T. A case of ovarian pregnancy diagnosed by MRI. Case Rep Obstetr Gynecol. 2015;2015:14303.






Case Reports