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This is a CTA of the abdomen and

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pelvis in a patient presenting with

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acute onset right-sided pelvic pain.

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When she came to the emergency department,

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her blood pressure was lower than expected

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for a patient of her age, and so they

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performed a FAST exam, which is an ultrasound

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survey of the abdominal quadrants.

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The FAST exam was positive for hemoperitoneum,

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and so despite a pending beta-HCG,

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the patient was sent for CTA of the abdomen and

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pelvis to further evaluate a source of bleeding.

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Arterial phase CT images are on the left

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side of the screen, and venous phase CT

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images are on the right side of the screen.

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Immediately as we enter the upper

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abdominal quadrants, we can see a

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significant amount of low-density free

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fluid surrounding the liver and spleen.

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If we draw a region of interest on this fluid,

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we can see that the internal attenuation is 37

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HU units, which is indicative of hemoperitoneum

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and confirms the findings at the FAST exam.

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As we scroll into the pelvis, we see

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a significant amount of hemoperitoneum

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layering along the right greater

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than left pericolic gutters as well.

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As we enter the pelvis, we see

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clotted blood products which are

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intermixed with the adjacent bowel.

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The uterus is best visualized on the

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venous phase images, and we can see a normal

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appearing uterus which is minimally enlarged,

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with a normal appearing endometrial cavity.

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In the right adnexa, there is a

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markedly peripherally enhancing

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structure with central hypoattenuation.

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And what's important to note

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about this structure is the

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degree of peripheral vascularity.

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We can also see a significant

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amount of recruited vasculature

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extending toward this structure.

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On the venous phase images adjacent to this

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structure, we can visualize the normal right

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ovary, which has a corpus luteum within it.

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The left ovary is also

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visualized in the left adnexa.

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So we have an extra-ovarian peripherally

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enhancing structure in the right adnexa

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with a significant amount of pelvic

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hemoperitoneum, with hemoperitoneum

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extending into the upper abdominal quadrants.

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Given the clinical history and the appearance

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of the imaging findings, concern was

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raised for a ruptured ectopic pregnancy.

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The patient was taken to the OR,

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which confirmed the diagnosis.