Objective: To determine the best Doppler values for differentiating ectopic pregnancy from a corpus luteum cyst of pregnancy. Show Methods: This was a prospective study of 80 consecutive patients with the diagnosis of ectopic pregnancy. All ectopic pregnancies were diagnosed on the basis of the presence of an extra-ovarian adnexal mass on sonography and were confirmed surgically. The last menstrual period ranged from 4 to 11 weeks (mean, 6.3 weeks), and the maximal ectopic pregnancy diameter ranged from 0.7 to 5.5 cm (mean, 2.5 cm). Seventy-six ectopic pregnancies showed color vascularity, and 40 showed corpus luteum cysts with vascular walls. The highest peak systolic velocity and the lowest resistive index of the vascular ectopic pregnancies were compared with the corresponding values in the vascular corpus luteum cysts. Results: The mean peak systolic velocity of the ectopic pregnancies was 35.4 cm/s compared with 28.4 cm/s in corpus luteum cysts, with no significant statistical difference (P = .1). The resistive index of the ectopic pregnancies ranged from 0.15 to 1.6 (mean +/- SD, 0.61 +/- 0.24) compared with 0.39 to 0.7 (mean, 0.52 +/- 0.10) in corpus luteum cysts, with a significant statistical difference (P = .003). In this cohort, a resistive index of less than 0.39 had a specificity of 100% and a positive predictive value of 100% for diagnosing ectopic pregnancy but was present in only 15% (confidence interval, 7%-23%) of ectopic pregnancies. A resistive index of greater than 0.7 had a specificity of 100% and a positive predictive value of 100% for diagnosing ectopic pregnancy and was present in 31% (confidence interval, 21%-41%) of ectopic pregnancies. Conclusions: Both low and high resistive indices discriminate ectopic pregnancy from a corpus luteum cyst. Objective: Pregnant patients without a sonographically visible intrauterine pregnancy and with a thick-walled cystic adnexal structure present a dilemma. This study compared the utility of various sonographic features in differentiating between the tubal ring of ectopic pregnancy and the corpus luteum. Methods: Retrospective review of first-trimester transvaginal sonograms revealed a cystic adnexal structure in 79 women. Each structure was evaluated for 6 specific sonographic characteristics: echogenicity of its wall compared with that of the ovary and endometrium, wall thickness in 2 planes, color Doppler flow distribution and percentage of wall circumference, and internal texture. Results: Forty-one (52%) of the 79 women had ectopic pregnancies, and 38 (48%) had corpora lutea. Eleven (32%) of 35 ectopic walls were more echogenic than the endometrium, compared with none of the corpora lutea. A cyst wall less echogenic than the endometrium was more likely in corpora lutea (84% versus 31%; P < .0001). More than twice as many ectopic rinds were more echogenic than ovarian tissue compared with corpora lutea (76% versus 34%; P < .0001). The only predictive internal texture feature was a clear pattern, which was more common in the corpora lutea (P < .01, Fisher exact test). There was no significant difference in mural flow distribution or extent between the 2 groups. Conclusions: Ancillary sonographic signs to distinguish between an ectopic pregnancy and a corpus luteum include decreased wall echogenicity compared with the endometrium and an anechoic texture, which suggests a corpus luteum. February 9, 2004 -- (Ultrasound Review) Radiologists at Einstein College of Medicine in New York City recently compared the sonographic appearances of the tubal ring of ectopic pregnancy with corpus luteum of the ovary. The tubal ring sign associated with an ectopic pregnancy consists of a thick-walled adnexal cystic structure shown separate to the ovary. When a pregnant patient presents with a similar structure adjacent to the ovary, but without clear separation, this could represent a corpus luteum or an ectopic pregnancy. Given the mortality issues associated with ectopic pregnancy, Dr Marjorie Stein and colleagues sought to distinguish these two entities through a comparison of ultrasound findings. Results were published in Journal of Ultrasound in Medicine. A retrospective review of first-trimester patients who had transvaginal ultrasound over a 20-month period revealed a cystic adnexal structure in 120 women with positive serum ß-human chorionic gonadotropin level. Seventy-nine women were included for study. Transvaginal imaging was performed using a 5 or 7 MHz, specialized transducer and color Doppler was employed. "Each adnexal cystic structure was evaluated for six specific sonographic characteristics: the echogenicity of the wall of the cyst compared with that of the ovarian parenchyma and with that of the endometrial lining (excluding any fluid or debris), the average thickness of the cyst wall in two planes, the echo texture within the cystic cavity, flow distribution within the wall, and percentage of wall circumference with flow," they reported. The adnexal mass was classified as clear when anechoic; lacy if multiple thin septations were present in a reticular pattern; solid if nonvascular soft-tissue was present; and ground-glass appearance if homogeneous low-level echoes were shown. Color Doppler was used to determine blood flow distribution. Flow was categorized as absent; present within the wall; present within the full thickness of the wall from the inner to outer margins of the rind; and peripheral to the wall. "Ancillary sonographic signs to distinguish between an ectopic pregnancy and a corpus luteum include decreased wall echogenicity compared with the endometrium and an anechoic texture, which suggests a corpus luteum," they concluded. Although hemoperitoneum was not found in patients with corpora lutea, but was found in patients with ectopic pregnancy, it was not a specific finding, as hemoperitoneum also was found in patients with ruptured ovarian cyst. Stein, M. W. et. al. Albert Einstein College of Medicine and Montefiore Medical Center, New York City. J Ultrasound Med 2004 January; 23:57-62 By Ultrasound Review Copyright © 2004 AuntMinnie.com How can you tell the difference between a corpus luteum cyst and an ectopic pregnancy?Conclusions: Ancillary sonographic signs to distinguish between an ectopic pregnancy and a corpus luteum include decreased wall echogenicity compared with the endometrium and an anechoic texture, which suggests a corpus luteum.
Can an ectopic pregnancy be mistaken for an ovarian cyst?Sonographic diagnosis of ovarian ectopic pregnancies remains extremely difficult, as their appearance can be easily misdiagnosed as a hemorrhagic cyst, a tubal ectopic, or a corpus luteum cyst (CLC).
Can you have a corpus luteum and an ectopic pregnancy?Observed in 15%–60% of cases of ectopic pregnancy (4–10), the observation of the corpus luteum in the ovary that is contralateral to the ectopic pregnancy is presumptive evidence for ovum transmigration.
Can corpus luteum cyst cause ectopic?The most important ovarian conditions that may suggest ectopic pregnancy are: (1) a corpus luteum or follicular cyst; (2) torsion of the pedicle of a cyst; (3) rupture of a cyst with or without intra-abdominal hemorrhage; (4) ovarian hemorrhage, and (5) hemorrhage into a cyst.
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Corpus luteum cyst vs ectopic pregnancy
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