(Radiology Review) By assessing a paraovarian pelvic mass with ultrasound imaging, clinicians could rule out ectopic pregnancy, retrospective study results suggest.
Because of its high morbidity, ectopic pregnancy should be excluded when an adnexal mass without an intrauterine pregnancy is demonstrated. An adnexal mass, however, could be either an ectopic pregnancy or a corpus luteum, Drs. Michael Blaivas and Matthew Lyon explain in their report, published in the Journal of Ultrasound in Medicine (May 2005, Vol. 24:5, pp. 599-603).
Drs. Blaivas and Lyon from the Medical College of Georgia in Augusta re-evaluated the endovaginal ultrasound videos of pregnant patients who had presented with signs or symptoms of concern for ectopic pregnancy over an 18-month period. Among the 78 patients with an adnexal mass without intrauterine pregnancy, 27 showed independent movement of the mass and ovary, which was more commonly found in patients with ectopic pregnancy.
"Independent movement of a mass and ovary was defined as movement of the mass away from the ovary, sliding past the ovary or rotation past the ovary," they stated. Twenty-three patients had an ectopic pregnancy confirmed, and only two of these patients showed no separation of the paraovarian mass and ovary with abdominal palpation and endovaginal transducer probing. Six patients without ectopic pregnancy had mass separation from the ovary.
"The tubal ring, a strong indicator of ectopic pregnancy on pelvic sonography, is classically described as a thick-walled adnexal structure that is either cystic or homogeneous in nature," they described. Color Doppler of ectopic pregnancy shows a characteristic 'ring of fire,' but corpus luteum may also show this color Doppler pattern.
According to the authors, independent movement of an adjacent mass and ovary, with abdominal and cervical palpation, was strongly associated with ectopic pregnancy.
"Reliability of Adnexal Mass Mobility in Distinguishing Possible Ectopic Pregnancy from Corpus Luteum Cysts"
Michael Blaivas and Matthew Lyon
Section of Emergency Ultrasound, Department of Emergency Medicine
Medical College of Georgia
1120 15th St, AF-2056
Augusta, GA 30912-4007 USA
J Ultrasound Med 2005 (May); 24:599-603
By Radiology Review
May 19, 2005
Copyright © 2005 AuntMinnie.com
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
