Ectopic pregnancy vs Ovarian torsion
How to tell Ectopic pregnancy and Ovarian torsion apart when a board question makes them look alike.
Ectopic starts with pregnancy status and absent intrauterine pregnancy; torsion starts with ovarian ischemia pattern.
Side by side
Positive pregnancy test with pelvic pain, vaginal bleeding, and no intrauterine pregnancy when expected.
Sudden unilateral pelvic pain with nausea/vomiting and enlarged ovary or reduced Doppler flow.
Implantation occurs outside the uterine cavity, most often in the fallopian tube.
Ovary twists on its vascular pedicle, threatening ischemia.
Positive beta-hCG plus no intrauterine pregnancy on transvaginal ultrasound when expected means ectopic until proven otherwise.
Adnexal enlargement and absent or reduced flow support torsion, but normal flow does not fully exclude it.
The trap
Both can present as acute unilateral pelvic pain, and torsion can still occur during pregnancy.
Watch it explained
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In acute pelvic pain, pregnancy test comes first; positive beta-hCG plus no intrauterine pregnancy means ectopic until proven otherwise, but pregnancy does not exclude torsion.
Try a free question
CoreA patient with missed period has unilateral pelvic pain, vaginal spotting, positive beta-hCG, and no intrauterine pregnancy on ultrasound when one is expected. Which diagnosis is most likely?
Show answer and explanation
Answer: A. Ectopic pregnancy. Positive pregnancy test with pain/bleeding and absent intrauterine pregnancy points to ectopic pregnancy.
Why the other choices are tempting
- B. Ovarian torsion causes sudden unilateral pain and ovarian ischemia clues; pregnancy does not exclude it.
- C. Appendicitis causes RLQ pain with GI/inflammatory features.
- D. PID causes cervical motion tenderness and infection signs.
- E. Endometriosis causes chronic cyclic pelvic pain.
Flashcards
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What is the fastest separator for Ectopic pregnancy vs Ovarian torsion?
Ectopic starts with pregnancy status and absent intrauterine pregnancy; torsion starts with ovarian ischemia pattern.
What clue should make you choose Ectopic pregnancy?
Positive pregnancy test with pelvic pain, vaginal bleeding, and no intrauterine pregnancy when expected.
Quick answers
What is the fastest way to tell Ectopic pregnancy from Ovarian torsion?
Ectopic starts with pregnancy status and absent intrauterine pregnancy; torsion starts with ovarian ischemia pattern.
What is the key clue for Ectopic pregnancy?
Positive pregnancy test with pelvic pain, vaginal bleeding, and no intrauterine pregnancy when expected.
What is the key clue for Ovarian torsion?
Sudden unilateral pelvic pain with nausea/vomiting and enlarged ovary or reduced Doppler flow.
What is the common trap with Ectopic pregnancy vs Ovarian torsion?
Both can present as acute unilateral pelvic pain, and torsion can still occur during pregnancy.