CASE REPORT article
Front. Med.
Sec. Obstetrics and Gynecology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1606074
This article is part of the Research TopicReviews in Obstetrics and Gynecology 2024View all 11 articles
Heterotopic Pregnancy After Adenomyosis Surgery: A Rare Case Highlighting Diagnostic Pitfalls and Clinical Insights
Provisionally accepted
- 1Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- 2Department of Pathology,Sir Run Run Shaw hospital,Zhejiang University, School of Medicine, Hang Zhou, China
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We present an extremely rare heterotopic pregnancy (HP) in a 33-year-old patient with multiple adenomyosis surgeries and bilateral salpingectomy, who conceived via assisted reproductive technology (ART). According to a two-decade literature review a review of the literature spanning two decades, concurrent intrauterine and extrauterine pregnancies are uncommon, especially intramural ectopic gestations in the case of intramural ectopic gestations.On Day 31 post-embryo transfer, only an intrauterine pregnancy (IUP) was observed by ultrasound. However, early vaginal bleeding and high-risk factors prompted further ultrasound, revealing an intramural ectopic pregnancy. Though MRI initially misdiagnosed the lesion, reevaluation led to the correct diagnosis. Surgical removal of the ectopic pregnancy was performed while preserving the IUP, which progressed uneventfully. By the late second trimester, follow-up MRI confirmed an intact posterior uterine myometrium, ruling out uterine rupture and resolving lingering concerns. This case illustrates a progression from incomplete ultrasound assessment to an early MRI misinterpretation an initial misinterpretation by MRI. Ultimately, complementary imaging was vital for accurately diagnosing and managing the intramural ectopic pregnancy, while safeguarding the intrauterine pregnancy by confirming uterine wall integrity later on. Highlighting the complexity of HP in a patient with adenomyosis conceived via ART, it underscores the importance of multiple imaging techniques for early diagnosis and ongoing monitoring in high-risk scenarios. These findings guide clinical strategies and emphasize the critical role of accurate imaging in protecting both maternal and fetal well-being.
Keywords: heterotopic pregnancy, Intramural pregnancy, Adenomyosis, ultrasound, Magnetic Resonance Imaging
Received: 04 Apr 2025; Accepted: 02 Jun 2025.
Copyright: © 2025 Zhu, Cao, Wang, Xu and Hu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Hongjie Hu, Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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