Mirror Image Artifact Mimicking Heterotopic Pregnancy on Transvaginal Ultrasound: Case Series

Malhotra, Radhika; Bramante, Robert; Radomski, Marek W.; Nelson, Mathew

doi:10.5811/westjem.2014.5.22508

Cited by 5 publications

(5 citation statements)

References 12 publications

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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%

Ectopic pregnancy secondary to in vitro fertilisation-embryo transfer: pathogenic mechanisms and management strategies

Refaat

Dalton

Ledger

2015

Reprod Biol Endocrinol

106

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BackgroundEctopic pregnancy (EP) is the leading cause of maternal morbidity and mortality during the first trimester and the incidence increases dramatically with in vitro fertilisation and embryo transfer (IVF-ET). The co-existence of an EP with a viable intrauterine pregnancy (IUP) is known as heterotopic pregnancy (HP) affecting about 1% of patients during assisted conception. EP/HP can cause significant morbidity and occasional mortality and represent diagnostic and therapeutic challenges, particularly during fertility treatment. Many risk factors related to IVF-ET techniques and the cause of infertility have been documented. The combination of transvaginal ultrasound (TVS) and serum human chorionic gonadotrophin (hCG) is the most reliable diagnostic tool, with early diagnosis of EP/HP permitting conservative management. This review describes the risk factors, diagnostic modalities and treatment approaches of EP/HP during IVF-ET and also their impact on subsequent fertility treatment.MethodsThe scientific literature was searched for studies investigating EP/HP during IVF-ET. Publications in English and within the past 6 years were mostly selected.ResultsA history of tubal infertility, pelvic inflammatory disease and specific aspects of embryo transfer technique are the most significant risk factors for later EP. Early measurement of serum hCG and performance of TVS by an expert operator as early as gestational week 5 can identify cases of possible EP. These women should be closely monitored with repeated ultrasound and hCG measurement until a diagnosis is reached. Treatment must be customised to the clinical condition and future fertility requirements of the patient. In cases of HP, the viable IUP can be preserved in the majority of cases but requires early detection of HP. No apparent negative impact of the different treatment approaches for EP/HP on subsequent IVF-ET, except for risk of recurrence.ConclusionsEP/HP are tragic events in a couple’s reproductive life, and the earlier the diagnosis the better the prognosis. Due to the increase incidence following IVF-ET, there is a compelling need to develop a diagnostic biomarker/algorithm that can predict pregnancy outcome with high sensitivity and specificity before IVF-ET to prevent and/or properly manage those who are at higher risk of EP/HP.

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Section: Resultsmentioning

confidence: 99%

Ectopic pregnancy secondary to in vitro fertilisation-embryo transfer: pathogenic mechanisms and management strategies

Refaat

Dalton

Ledger

2015

Reprod Biol Endocrinol

106

View full text Add to dashboard Cite

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“…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%

Thyroid cyst mirror artifact mimicking a tracheal cyst on ultrasound in a patient with excessive trachea collapsibility

You

Kim

et al. 2018

Radiology Case Reports

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Mirror image artifact in ultrasound is not an unusual phenomenon. However, it is rarely seen in thyroid ultrasound because of the natural convexity of the tracheal surface. We report a mirror artifact during thyroid ultrasound in a patient with an excessively collapsible trachea. Minor pressure with the transducer made the trachea surface flat or concave, and then a cyst in the thyroid was mirrored across the trachea, which mimicked an intratracheal cyst. This case illustrates how an unusual collapsible trachea can generate an image that simulates an intratracheal lesion during thyroid ultrasound.

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“…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%

Just a mirage: heterotopic intrauterine and twin ectopic pregnancy mimicked by mirror imaging on ultrasound

Ahmed

Samardzic

Santos

et al. 2017

Radiology Case Reports

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Heterotopic pregnancies are rare and are usually diagnosed by transvaginal ultrasound. Despite the routine use of sonography in early pregnancy, artifact created by mirror imaging can drastically and erroneously alter medical decision making by interfering with image interpretation. A heterotopic pregnancy with a single intrauterine gestation and twin left adnexal ectopic gestational sacs was observed on ultrasound in a woman presenting with abdominal pain. During laparoscopy, an ectopic pregnancy was not identified, and subsequent intraoperative ultrasound reproduced the heterotopic pregnancy through manipulation of bowel, confirming mirror image artifact. This phenomenon is rarely seen in obstetric imaging; therefore, lack of awareness can lead to false diagnosis of heterotopic pregnancy. Techniques to verify correct diagnosis should be used to resolve potential mirror artifact before proceeding with surgical management.

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Mirror Image Artifact Mimicking Heterotopic Pregnancy on Transvaginal Ultrasound: Case Series

Cited by 5 publications

References 12 publications

Ectopic pregnancy secondary to in vitro fertilisation-embryo transfer: pathogenic mechanisms and management strategies

Ectopic pregnancy secondary to in vitro fertilisation-embryo transfer: pathogenic mechanisms and management strategies

Thyroid cyst mirror artifact mimicking a tracheal cyst on ultrasound in a patient with excessive trachea collapsibility

Just a mirage: heterotopic intrauterine and twin ectopic pregnancy mimicked by mirror imaging on ultrasound

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