Objective

To report a peculiar case of ultrasound diagnosis of spontaneous angular twin pregnancy. In literature, the terms “angular,” “interstitial,” and “cornual” pregnancies are often used inappropriately. Confusion in terminology may have contributed to difficulties in developing diagnostic ultrasound criteria to differentiate these ectopic pregnancies.

Design

Case report.

Setting

Obstetrics and Gynecology, Community Hospital “S. Maria delle Croci.”

Patient

A 28-year-old patient with a previous cesarean delivery was admitted to our hospital for management of a presumed angular ectopic pregnancy. Transvaginal ultrasound confirmed an ectopic dichorionic diamniotic twin pregnancy eccentrically located in the right superior angle of the uterine cavity: the first gestational sac appeared to have right angular implantation, whereas the second gestational sac seemed to deepen inside the myometrium, with a thin myometrial margin of only 3 mm.

Interventions

After discussing the risks, the patient requested to proceed with termination. A single intramuscular injection of 75 mg of methotrexate was administered, followed by ultrasound-guided hysterosuction after 19 days due to severe vaginal bleeding.

Main Outcome Measures

An early and accurate ultrasound diagnosis of a high-risk condition allowed for conservative medical treatment.

Results

The serum beta-human chorionic gonadotropin levels progressively decreased. After 1 month, a clinical and ultrasound examination showed a regular endometrial line with a regular reappearance of menstrual bleeding.

Conclusions

Although there are remarkable advances in ultrasound techniques, angular pregnancy remains a condition of difficult diagnosis and management; it is potentially dangerous and may lead to severe complications. An early and accurate diagnosis of this condition is necessary to avoid complications and individualize the subsequent management.

中文翻译：

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自发角双绒毛膜双羊膜双胎妊娠：1例报告

客观的

报告一例自发性角双胎超声诊断的特殊病例。在文学作品中，术语“角形”、“间质性”和“角形”妊娠经常被不当使用。术语混乱可能导致难以制定诊断超声标准以区分这些异位妊娠。

设计

案例报告。

环境

妇产科，社区医院“S. 玛丽亚·德尔·克罗奇。”

病人

一名 28 岁的既往剖宫产患者因疑似异位妊娠而入院。经阴道超声证实异位双绒毛膜双羊膜双胎妊娠偏心位于子宫腔右上角：第一个妊娠囊似乎有直角着床，而第二个妊娠囊似乎在子宫肌层内加深，子宫肌层边缘较薄。只有 3 毫米。

干预措施

在讨论了风险后，患者要求继续终止治疗。由于严重的阴道流血，单次肌肉注射 75 mg 甲氨蝶呤，19 天后进行了超声引导下的子宫抽吸术。

主要观察指标

对高危疾病的早期准确超声诊断允许进行保守治疗。

结果

血清β-人绒毛膜促性腺激素水平逐渐下降。1个月后，临床和超声检查显示子宫内膜线正常，月经出血规律再次出现。

结论

尽管超声技术取得了显着进步，但角妊娠仍然是一个难以诊断和管理的疾病。这是潜在的危险，并可能导致严重的并发症。有必要对这种情况进行早期和准确的诊断，以避免并发症和个体化后续管理。