Diagnostic Accuracy of Chronic Tubal Abortion vs. Other Adnexal Masses in Women Presenting with Pelvic Pain - Retrospective Observational Study

Authors

  • Rathna A
  • Nidhi Sharma

Keywords:

PCOS, metformin, immunomodulation, mTOR, TGFβ1, IL6

Abstract

Background: Chronic tubal abortion is a rare and underrecognized variant of ectopic pregnancy wherein degenerative gestational tissue persists within the fallopian tube, forming an adnexal mass that clinically mimics ovarian neoplasms or tubo-ovarian abscesses. Unlike acute ruptures, these cases present insidiously with nonspecific symptoms and variable β-hCG levels, complicating timely diagnosis.

Methods: This retrospective observational study included 78 reproductive-age women (18–45 years) who presented with adnexal masses and were ultimately diagnosed with chronic tubal abortion based on clinical, radiological, and histopathological findings. Data included demographics, symptoms, β-hCG levels, imaging reports (ultrasound, MRI), and outcomes. Diagnostic accuracy was assessed by comparing imaging findings with final histopathology.

Results: Common presenting features included pelvic pain (82.1%), vaginal bleeding (68.9%), and amenorrhea (54.8%). β-hCG was <1000 mIU/mL in 62.8% of cases. Ultrasound revealed heterogeneous masses in 71.8%, while MRI identified tubal wall thickening and hemorrhagic components in 78.1% and 65.6% respectively, significantly improving diagnostic accuracy. The misdiagnosis rate was 44.9%, with common alternate diagnoses being ovarian cysts and abscesses. Treatment primarily involved laparoscopic salpingectomy (53.8%) or methotrexate therapy (23.1%). Complications included tubal rupture (10.3%) and persistent trophoblastic tissue (5.1%).

Conclusion: Chronic tubal abortion should be considered in reproductive-age women with adnexal masses and nonspecific symptoms. MRI enhances diagnostic accuracy over ultrasound, and early recognition prevents complications. Surgical and medical management should be tailored to individual presentations for optimal outcomes.

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References

Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N. Sites of ectopic pregnancy: a 10-year population-based study of 1800 cases. Hum Reprod. 2002;17(12):3224-30. PubMed: 12456628

Kirk E, Bottomley C, Bourne T. Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location. Hum Reprod Update. 2014;20(2):250-61. PubMed: 24101604

Creanga AA, Shapiro-Mendoza CK, Bish CL, Zane S, Berg CJ, Callaghan WM. Trends in ectopic pregnancy mortality in the United States: 1980-2007. Obstet Gynecol. 2011;117(4):837-43. PubMed: 21422853

Lin EP, Bhatt S, Dogra VS. Diagnostic clues to ectopic pregnancy. Radiographics. 2008;28(6):1661-71. PubMed: 18936028

Kao LY, Scheinfeld MH, Chernyak V, Rozenblit AM, Oh S, Dym RJ. Beyond ultrasound: CT and MRI of ectopic pregnancy. AJR Am J Roentgenol. 2014;202(4):904-11. PubMed: 24660723

Timor-Tritsch IE, Monteagudo A, Matera C, Veit CR. Sonographic evolution of cornual pregnancies treated without surgery. Obstet Gynecol. 1992;79(6):1044-9. PubMed: 1579300

Barnhart KT, Sammel MD, Gracia CR, Chittams J, Hummel AC, Shaunik A. Risk factors for ectopic pregnancy in women with symptomatic first-trimester pregnancies. Fertil Steril. 2006 Jun;86(1):36–43. doi:10.1016/j.fertnstert.2006.01.014. PMID: 16762134.

Lev-Toaff AS, Coleman BG, Arger PH, Mintz MC, Arenson RL, Toaff ME. Ectopic pregnancy: diagnosis with transvaginal sonography. Radiology. 1990 Jun;175(3):733–6. doi:10.1148/radiology.175.3.2343126. PMID: 2343126.

Hajenius PJ, Mol F, Mol BW, Bossuyt PM, Ankum WM, Van der Veen F. Interventions for tubal ectopic pregnancy. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD000324. doi:10.1002/14651858.CD000324.pub2. PMID: 17253495.

Menon S, Colins J, Barnhart KT. Establishing a human chorionic gonadotropin discriminatory zone for ultrasound diagnosis of ectopic pregnancy. Fertil Steril. 2007 Apr;87(4):681–6. doi:10.1016/j.fertnstert.2006.11.001. PMID: 17224180.

Togashi K, Nishimura K, Sagoh T, Minami S, Noma S, Fujisawa I, et al. Ectopic pregnancy: MRI diagnosis. Radiology. 1988 Dec;169(3):777–80. doi:10.1148/radiology.169.3.3175007. PMID: 3175007.

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Published

2025-06-12

How to Cite

1.
A R, Sharma N. Diagnostic Accuracy of Chronic Tubal Abortion vs. Other Adnexal Masses in Women Presenting with Pelvic Pain - Retrospective Observational Study. J Neonatal Surg [Internet]. 2025Jun.12 [cited 2025Sep.13];13(1):269-76. Available from: https://www.jneonatalsurg.com/index.php/jns/article/view/7312

Issue

Vol. 13 (2024): Journal of Neonatal Surgery

Section

Original Article

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