Intramural pregnancy presenting in a patient with tuberous sclerosis

Abstract

Intramural pregnancies are a rare form of ectopic pregnancy located within the myometrium separate from the endometrial cavity. In an effort to prevent potential complications, diagnosis should be made early when more conservative approaches can be performed to preserve reproductive potential. The diagnosis of ectopic pregnancies can be successfully accomplished through sonography; however, intramural pregnancies may be difficult to diagnose as they can appear similar to other etiologies. We present a unique case of a ruptured intramural pregnancy diagnosed with sonography and pelvic MRI in a patient with tuberous sclerosis. Surgical enucleation of the intramural pregnancy was successfully performed with postoperative resolution of beta hCG levels.

Spontaneous intramyometrial pregnancy mimicking an intramural myoma: a diagnostic challenge

“…This supports the theory of uterine wall invasion by placenta accreta and subsequent growth of the fetus deep in the myometrium, as described by Bernstein et al [10]. Differential diagnosis based on 2D ultrasound remains difficult and may suggest a number of possibilities, including interstitial or cornual ectopic pregnancy, degenerating myoma, pregnancy in a congenitally abnormal uterus [1], sarcoma or molar pregnancy [11], or unruptured intramyometrial pregnancy.…”

“…Its etiology remains unclear, but most authors attribute it to a sinus tract within the endometrium caused by previous uterine surgery or manipulation [1,3,4], adenomyosis [5,6], or a difficult embryo transfer [1,[7][8][9]. Leyder et al described intramyometrial pregnancy after an embryo transfer following uterine artery embolization [9], and Glass et al described a case in a woman with tuberous sclerosis [11]. In our case, there was no previous uterine surgery or previous intrauterine manipulation and no sinus tract was found during hysteroscopy.…”

“…The use of pelvic MRI allows visualization of multiple scan planes and helps to define the distance between the intramyometrial pregnancy and the uterine cavity [1,3,11,12]. Ko et al proposed MRI to distinguish an unruptured intramyometrial pregnancy, which looks like a homogeneous hyperintense mass on T2-weighted images, from a ruptured one, that shows a heterogeneous signal intensity on T2-weighted images.…”

“…Laparoscopic treatment with opening of the surrounding myometrium and suture by interrupted stitches was performed in a patient with an intramyometrial pregnancy in a myomectomy scar [4] and another who had undergone previous left salpingectomy [14]. Enucleation by laparotomy was also carried out for intramyometrial pregnancy after right adnexectomy [15] and due to massive hemoperitoneum [11].…”

Transfemoral temporary aortic balloon occlusion in surgical treatment of second trimester intramural ectopic pregnancy

“…Laparotomy of large ectopic gestational mass carries the risk of significant hemorrhage, which may lead to hysterectomy. 6 One intramural pregnancy in a healthy woman at 37 weeks of gestation led to emergency hysterectomy with transfusion because of the uncontrollable uterine bleeding during cesarean section. 4 In another case of intramural pregnancy, hysterectomy was performed at 30 weeks gestation after the patient delivered a surviving neonate.…”