Ovarian ectopic pregnancy can be visualized as wide echogenic ring with an internal echolucent area. The echogenic ring seemed to be on the surface of the ovary or within the substance of the ovary. At surgery, the ovarian pregnancies had the appearance of a hemorrhagic ovarian cyst. A yolk sac or embryo was seen less commonly. 卵巢内异位妊娠可表现为较大范围的环状回声,其内见高回声区.环状回声可出现在卵巢表面也可出现在卵巢实质内.卵巢内异位妊娠手术时可看到整个卵巢像个血性包块.卵黄囊及胚胎组织很少被发现.
Although the presence of pelvic fluid can have many causes other than a ruptured ectopic pregnancy (including a ruptured ovarian cyst and pelvic inflammatory disease), in the face of a positive pregnancy test in the absence of an intrauterine pregnancy, the finding of fluid in the pelvis must be considered strong evidence for ectopic pregnancy. Echogenic fluid, when moderate or large in amount, has a positive predictive value of 86% to 93% for ectopic pregnancy (Fig. 21).22 In as many as 15% of cases of ectopic pregnancy, the presence of fluid may be the only sonographic finding.30 Massive hemorrhage from a ruptured tubal or ovarian pregnancy leads to symptoms of shock. 除了异位妊娠外卵巢囊肿破裂/盆腔炎也可出现盆腔积液.但妊娠试验阳性者出现盆腔积液,而宫内无妊娠征象,需警惕异位妊娠的可能性.出现中等量或大量有回声的液体,异位妊娠阳性率可达86%-93%(图21).多达15%的异位妊娠以盆腔积液为唯一超声表现.输卵管/卵巢妊娠破例出血可导致休克
SUMMARYOFKEY POINTS 要点汇总 Ultrasound is certainly a modality of choice for the evaluation of a female patient presenting with acute pelvic pain. The uterus and adnexa should be evaluated carefully for the various causes of pelvic pain, as discussed previously. Hemorrhagic cyst is by far the most common cause of acute pelvic pain in a nonpregnant female patient and usually presents with classic sonographic findings. One should be familiar with its variable presentations, however, and should obtain a follow-up ultrasound examination before sending the patient for surgery. Correlation of sonographic findings with the clinical history is helpful in arriving at a definitive diagnosis (eg, in distinguishing pyosalpinx from endometriosis). Pelvic ultrasound and the serum b-hCG level are used to diagnose and exclude ectopic pregnancy. MR imaging should be considered to make a specific diagnosis in certain cases in which ultrasound findings are indeterminate. 超声检查作为基本检查项目在出现急性小腹痛的年轻女性患者(病情判断)中是具有肯定价值的.各种小腹痛都应仔细检查分析子宫及附件情况出血性囊肿则在未孕女性中更为常见,并有典型的超声表现.医师们应该熟悉其各种超声表现,并在送往手术前反复仔细探查.将声像图与临床病史密切结合有助于鉴别诊断(如输卵管积脓与子宫内膜异位症鉴别).盆腔超声检查和血b-hcg用于诊断和排除异位妊娠.MRI用于超声诊断不明确时的特殊情况..