Fig. 33

Ectopic pregnancy in the cesarean scar. A 29-year-old female patient presenting with recent onset post-coital bleeding. Gynecological examination was suspicious for a cervical mass. Serum beta-hCG level was mildly elevated (2100 mIU/mL). a Transvaginal gray scale US examination clearly outlined a mass (arrows) with central cystic component (asterisk) and thick walls. There were no detectable fetal elements nor fetal cardiac activity within the cystic component of the lesion. b, c Sagittal plane T2W and T1W postcontrast images, respectively, better demonstrate the same lesion with central cystic component and intense enhancement in its thick walls (arrowheads). Also note was made of thick endometrial lining suggestive of decidual reaction (arrow). The imaging and laboratory findings were inconclusive but a conservative approach was elected as the patient expressed her desire to preserve fertility. Oral methotrexate was started and a simultaneous endoarterial embolization was performed. d Intense vascularity was noted at the site of the lesion in pre-embolization angiography (arrowheads). e The lesion becomes completely devascularized after embolization (arrowheads). Her recovery was uneventful and serum beta-hCG levels precipitously dropped after these treatments. f Axial plane postcontrast abdominal CT image 2 year after the initial presentation showed a small residual cystic lesion (arrows), and confirmed almost complete regression of this mass