Multimodal Imaging Vital in Diagnosing Rare Intramural Pregnancy

Two cases of occult heterotopic intramural ectopic pregnancy (HIMP) following multiple abortions were reported by a team in China. These cases posed challenges in diagnosis using early two-dimensional transvaginal sonography (TVS). The team employed multimodal imaging, including transabdominal ultrasound (TAS), color Doppler flow imaging (CDFI), three-dimensional TVS, and magnetic resonance imaging (MRI) for early diagnosis. The combination of these techniques, along with serum β-human chorionic gonadotropin (β-hCG) levels, proved crucial in preventing the catastrophic consequences of HIMP. IMP is a rare type of ectopic pregnancy where the pregnancy implants within the uterine wall, posing a risk of uterine rupture and hemorrhage. The exact cause of IMP remains unknown, but factors like uterine trauma and pelvic surgery have been identified as potential risk factors. Early diagnosis of IMP is vital to prevent severe complications, and differentiating IMP from other conditions like intrauterine pregnancy can be challenging. Multimodal imaging techniques like three-dimensional TVS and MRI play a crucial role in accurate diagnosis and treatment planning for IMP. In one case, a 30-year-old woman with a history of abortions presented with elevated serum β-hCG levels, leading to a diagnosis of intrauterine pregnancy complicated by a fundic intramural pregnancy. Surgical intervention was required to remove the gestational sac tissue. In another case, a 41-year-old woman with intermittent vaginal bleeding was diagnosed with an incomplete intramural pregnancy, which was successfully treated with hysteroscopic removal of the gestational sac. These cases highlight the importance of accurate diagnosis in preventing severe complications associated with IMP. Multimodal imaging techniques and clinical vigilance are essential in managing cases of IMP, especially when conventional two-dimensional TVS results are inconclusive. Expert commentary emphasizes the significance of combining imaging modalities and serum β-hCG monitoring for effective diagnosis and treatment planning in cases of HIMP and IMP.