2014
DOI: 10.5811/westjem.2014.5.22508
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Mirror Image Artifact Mimicking Heterotopic Pregnancy on Transvaginal Ultrasound: Case Series

Abstract: Vaginal bleeding in early pregnancy is a common emergency department complaint. Point-of-care ultrasound is a useful tool to evaluate for intrauterine ectopic pregnancy. Emergency physicians performing these studies need to be cognizant of artifacts produced by ultrasound technology, as they can lead to misdiagnosis. We present two cases where mirror-image artifacts initially led to a concern for heterotopic pregnancies but were excluded on further imaging.

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Cited by 5 publications
(5 citation statements)
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“…One study found that patients with abnormal cul-de-sac fluid were five times more likely to have HP as patients without it [ 127 ]. Causes of misdiagnosis include misidentification of an HP as a corpus luteal cyst [ 122 , 127 ] or due to mirror image artefact on TVS due to the patient having a full bladder during the process, which causes reflection of a viable IUP on a different part of the image and could be mistakenly diagnosed as HP [ 128 ].…”
Section: Resultsmentioning
confidence: 99%
“…One study found that patients with abnormal cul-de-sac fluid were five times more likely to have HP as patients without it [ 127 ]. Causes of misdiagnosis include misidentification of an HP as a corpus luteal cyst [ 122 , 127 ] or due to mirror image artefact on TVS due to the patient having a full bladder during the process, which causes reflection of a viable IUP on a different part of the image and could be mistakenly diagnosed as HP [ 128 ].…”
Section: Resultsmentioning
confidence: 99%
“…This phenomenon doubles the round-trip time for each point within the mass and registers the echoes equidistant on the opposite side of the reflector surface. Mirror artifacts have been reported in many body parts, including abdominal [1] , [2] , obstetric [3] , [4] , [5] , cardiac [6] , vascular [7] , [8] , [9] , and musculoskeletal ultrasound [6] , [10] . Our literature search showed that only 1 case of mirror image has been reported during thyroid imaging [11] .…”
Section: Discussionmentioning
confidence: 99%
“…However, mirror imaging is rarely noted in pelvic sonography despite the regular use of TVUS in obstetrics and gynecology. There are 3 prior case reports and 1 case series of intrauterine gestational sacs mirroring to create the appearance of ectopic gestational sacs [1] , [5] , [6] , [7] . However, unlike our case, in the previous reports, the mirror image artifact resolved on reimaging or after emptying or filling the bladder.…”
Section: Discussionmentioning
confidence: 99%
“…Cases of mirror image artifact in obstetrical imaging have now been demonstrated via transabdominal and transvaginal approach, with a full and empty bladder, and when the intrauterine gestational sac is beyond the field of view [1] , [5] , [6] , [7] . The variability of presentation can make pseudo-heterotopic pregnancy a challenging entity to recognize.…”
Section: Discussionmentioning
confidence: 99%