Wednesday, January 14, 2009


This is an easy case, but I wanted to share the beautiful picture above, and the diagnosis is a crucial one to make.

A 20 year old woman presents with abdominal pain, breast tenderness, frequent urination, nausea, and shoulder pain. Her LMP was 8 weeks ago, but she's noted some vaginal bleeding. She has a history of pelvic inflammatory disease. Her sexual debut was at age 16. She has no surgical history.

Challenge: A pathologic image of this disease is shown above. What is it?

Image is in the public domain.


CodeDog said...

A parasitic infestation caused by coitus; otherwise known as pregnancy.

shabnam said...

Ectopic pregnancy...looks like tubal,actually.

CodeDog said...

Since she has abdominal pain, vaginal bleeding, breast tenderness and amenorrhea, she should be checked for an ectopic.

The history of pelvic inflammatory disease increases her risk for an ectopic pregnancy

Stephanie said...

ectopic pregnancy. lovely photo, craig. :O)

Alex said...

check hcg, abdominal US

Craig Chen said...


Ectopic pregnancy presents with abdominal pain, amenorrhea, and vaginal bleeding as well as normal pregnancy discomforts typically 6-8 weeks after LMP. Diagnosis is made clinically based on results of transvaginal ultrasound and beta-HCG. Risk factors include previous ectopic, tubal surgery, tubal pathology, in utero DES exposure, current IUD use, infertility, h/o cervicitis or PID, multiple sexual partners, and smoking.

The photo shows an opened oviduct with an ectopic pregnancy featuring a well preserved 10-millimeter embryo. Even an embryo this tiny shows very distinct anatomic features, including tail, limb buds, heart, eye cups, cornea/lens, brain, and prominent segmentation into somites. The gestational sac is surrounded by a myriad of chorionic villi. This embryo is about five weeks old.

Sources: UpToDate; Wikipedia.