QUIZ: No. 17, 17/05/2026

Diagnosis: Chronic ectopic pregnancy with organized pelvic hematocele

Findings:

CT and MRI pelvis demonstrate a large heterogeneous left adnexal/pelvic mass lesion with hemorrhagic components. The lesion shows mixed signal intensity with T1 hyperintense areas representing blood products and heterogeneous T2 signal intensity. Patchy areas of diffusion restriction corresponding to inflammatory granulation tissue and organized hematoma. No definite intrauterine or extrauterine gestational sac is identified. A thin tubular structure separate from the main lesion is visualized adjacent to the mass, representing residual fallopian tube

Discussion

• Chronic ectopic pregnancy results from repeated minor tubal rupture or tubal abortion with gradual leakage of blood and trophoblastic tissue into the pelvis.

• The spilled hemorrhagic and trophoblastic material undergoes organization with formation of granulation tissue, fibrosis, adhesions, and organized hematoma, producing a pseudotumoral adnexal mass.

• Unlike acute ectopic pregnancy, a well-defined gestational sac or fetal pole is often absent, making diagnosis challenging.

• The residual fallopian tube may appear relatively normal or separately visualized because the organized pelvic mass no longer represents the intact tubal lumen itself.

• Chronic ectopic pregnancy is a known radiologic mimicker of tubo-ovarian abscess, endometrioma, and ovarian neoplasm.

Teaching pearl:

A complex hemorrhagic adnexal mass with a separately visualized residual fallopian tube in a reproductive age group female with elevated Beta HCG should raise suspicion for chronic ectopic pregnancy with organized pelvic hematocele .