RT Journal
A1 Lyons N, Halat S, Conway W
T1 IMage of the month—quiz case
JF Archives of Surgery
JO Archives of Surgery
YR 2012
FD October 1
VO 147
IS 10
SP 975
OP 975
DO 10.1001/archsurg.2011.1494a 10.1001/archsurg.2011.1494b
UL http://dx.doi.org/10.1001/archsurg.2011.1494a 10.1001/archsurg.2011.1494b
AB 
Two weeks before presentation, the patient was seen at an outside hospital reporting severe posterolateral pain on the right side of the neck and mild generalized abdominal pain. Preliminary laboratory evaluation results revealed a hemoglobin level of 8.0 g/dL (to convert to grams per liter, multiply by 10) and an increased human chorionic gonadotropin level of 1500 mIU/mL (conversion to international units per liter is 1:1). The obstetrics department was consulted and diagnosed an ectopic pregnancy of approximately 5 weeks' gestation after transvaginal ultrasonography failed to show intrauterine products of conception. The patient was taken to the operating room for diagnostic laparoscopy, and 600 mL of blood was evacuated from her pelvis; no ectopic pregnancy was visualized. The patient was then discharged home. At follow-up 1 week later, the human chorionic gonadotropin level remained elevated at 1600 mIU/mL prompting treatment with methotrexate sodium.