Re: intrauterine ectopic
From: art fougner, md (evsono@pipeline.com)
Sun Aug 25 11:06:30 2002
Martin -
have seen as Terry so fondly calls it - embryonic cardiac activity with
1 mm fetal poles using 7 - 8 Mhz frequency vaginal transducers.
Sharon -
have seen for want of a better term - intra-amniotic yolk sacs twice -
both pregnancies ended in spontaneous Ab. wonder if your findings could
represent the early appearance of the extrachorial gestation? do you
have images? i sense a case report.
art
At Sat, 24 Aug 2002, Sharon Brown wrote:
>
>At Sat, 24 Aug 2002, Martin Necas wrote:
>>
>>Dear Sharon,
>>
>>I don't think it is possible to get fetal heart tones at 6-7 weeks GA.
>>That's just way too early.
>>
>>>From your description, are you saying that the embryo is outside the
>>gestational sac and outside the endometrium... so that seems to imply
>>that the embryo is within the myometrium?
>>
>>A couple things that I thought of with your desciption was for example
>>small focal subchorionic clot pulsating with maternal heart beat.
>>
>>Usually when I see something really strange on a first trimester scan, I
>>would ask myself:
>>1) does bHCG correlate with the ultrasound findings?
>>2) does LMP correlate with the ultrasound findings?
>>3) does FH Rate correlate with CRL
>>
>>If I think I'm seeing a heartbeat, but I'm not entirely sure if it may
>>be from maternal pulsation or embryonic in origin, a neat trick is to
>>grab the patient's wrist and see if the embryonic heartbeat is different
>>rate. If not, it's probably transmitted pulsation from the mother.
>>
>>I hope this helps. A set of images would be great.
>>
>>Yours,
>>
>>--
>>Martin Necas
>>RDMS, RVT
>>
>>At Fri, 23 Aug 2002, Sharon Brown wrote:
>>>
>>>I need info if posible. Last week I was sent a patient from the ER, in
>>>which the doc told the woman that he found fetal heart tones. I did a
>>>transvag and found a gestational sac with a yolk sac within. However,
>>>hard as I looked I couldn't find a fetal pole. As I was scanning the
>>>uterus I found what the doc was talking about. The problem is that the
>>>fetal pole that I found was outside of the gestational sac and it did
>>>have heart motion, it was also hyperechoic. I am completely baffeled by
>>>this, and the Rad that I showed the images and talked with couldn't
>>>quite figure it out either. How is it possible that a fetus can reach
>>>the 6-7 week stage outside of the gestational sac, and what would cause
>>>it to implant outside of the endometrious, yet still within the uterus.
>>>It was in the area where one would normally find a sub chorionic bleed.
>>>The fetal pole and the yolk sac both measured 4 mm. Any help would be
>>>appreciated. Thanks Sharon
>>
>--
>Thanks for your input. Hopefully I will be able to speak with the radiologist
>that read the scan. He wanted to do some research and said he would let me
>know what he found out. The motion was too fast to be that of the mother. The
>heart motion was discovered by the ER doc before referring the patient to me.
>At first I thought he was mistaken because of the empty sac, however when I did
>find what he was referring to I did my own testing and found heart motion a
>posibility in the absence of anyother logical conclusion. I am not an expert
>in ob and so far what I have seen has been pretty straight forward. I was unprepared
>for this finding. I will certainly let all know what it turns out to be if possible.
>again thanks for your response. Sharon
>
>I will try to get permission to upload a couple of images. At this point I
>don't know what to think.
>
--
art fougner, md
ich bin ein New Yorker
