Amplitude ultrasonic angiography-assisted diagnosis and management of cervical pregnancy

An unusual manifestation of cervical pregnancy in a 22-year-old woman is reported. The patient was referred to our clinic with a positive pregnancy test and after a massive hemorrhage. Vaginal examination revealed a purplish, globular and enlarged cervix measuring 6-7 cm with a partially dilated external os. Sonographic examination showed an empty uterine cavity with a clearly defined endometrial echo and a barrel-shaped heterogeneous mass within the cervix. Pulsatile blood flow was found within this confluent cervical mass on color Doppler imaging. Amplitude ultrasonic angiography was utilized to investigate this further, and very prominent vascularity was detected in the cervical mass. Chemotherapy was given and monitored with serial quantitative serum β-human chorionic gonadotropin levels and sonography but failed. The amplitude ultrasonic angiography utilized here correlated well with the pathological findings after hysterectomy. The persistently high vascularity after chemotherapy demonstrated by amplitude ultrasonic angiography may be an indication of treatment failure, and surgical intervention should be expedited in this life-threatening situation.