A transvaginal ultrasound is the most important diagnostic tool for an ectopic pregnancy. Adnexal complex or simple cyst with ring of fire appearance with colour doppler is the most specific feature. Presence of free fluid in pouch of douglas indicates rupture of ectopic pregnancy. Live extra uterine pregnancy with demonstrable cardiac activity is 100% specific of ectopic pregnancy. Empty uterine cavity with thick endometrium also corroborates with the diagnosis. Rare presence of pseudo-gestational sac and heterotopic pregnancy will pose challenges in diagnosis of ectopic pregnancy. Expertise and caution are both required while doing early pregnancy scan for evaluation and diagnosis of ectopic pregnancy.
Simple ovarian cyst:
Ovarian cyst especially simple cyst are sometimes incidental findings during a routine ultrasonography. Transvaginal ultrasonography is the gold standard for assessment of ovarian cysts. Round or oval cyst with smooth thin walls suggests a simple ovarian cyst. Follicular cysts, Corpus luteal cysts and theca lutein cysts are some of the simple ovarian cysts commonly noted in women of reproductive age. Follow up requires serial transvaginal ultrasonography. Competent and diligent ultrasonography is all that is required for thorough evaluation of simple ovarian cyst.
Complex ovarian cyst:
Diagnosis of ovarian cyst is more often done by ultrasound than by physical examination. Complex ovarian cyst ultrasonography is challenging, as it is of foremost importance for the doctor to identify differentiating signs of benign from malignant cysts. Irregular multilocular cysts, solid cysts, cysts with papillary structures, presence of ascites and high blood flow on doppler examination will all point towards malignant ovarian cyst. Meticulous and complete ultrasonography arouses the suspicion of a malignant cyst and further confirmative procedures can be undertaken.