The Endomyometrial Thick...on by Pelvic Sonography

he ease and accessibility of sonography has made it the imaging modality of choice for emergency physicians, obstetrician-gynecologists, and other medical specialists evaluating patients with early pregnancy-related symptoms. Although 95% to 98% of ectopic pregnancies are tubal in location, 2% to 4% are interstitial ectopic pregnancies, known as interstitial pregnancies. By definition, an interstitial pregnancy occurs when a fertilized embryo implants eccentrically within the intramural portion of the proximal fallopian tube enveloped by myometrium.1–3 Risk factors are generally similar for both tubal and interstitial pregnancies: ie, previous ectopic pregnancy, previous salpingectomy, in vitro fertilization, and a history of sexually transmitted disease.1,2 In the literature, often erroneously, the terms “interstitial pregnancy” and “cornual pregnancy” are used interchangeably. Some authors have used the term “proximal ectopic pregnancy” to encompass both pathologic findings4; however, the two remain distinct entities. A cornual pregnancy is intrauterine and specifically refers to the implantation and development of a gestation in one of the upper, lateral portions of the uterus in a patient with a rudimentary horned, septated, or bicornuate uterus. A cornual pregnancy often leads to a complicated but viable pregnancy. An interstitial pregnancy, however, is a category of ectopic pregnancy, which is often associated with high morbidity and mortality rates. Consideration of this diagnosis before rupture has a direct effect on treatment options and patient outcomes. Although an interstitial pregnancy is of prime Resa E. Lewiss, MD, Nadia M. Shaukat, MD, Turandot Saul, MD, RDMS