Teenager with syncope and vaginal bleeding who has a positive betaHCG test and who denies sexual activity

CT of ruptured ectopic pregnancy
Sagittal CT with contrast of the abdomen (above left) shows in the pelvis from anterior to posterior – a fluid filled bladder, an enhancing uterus, and a solid appearing homogenous mass compressing the rectum behind it. Coronal CT (above right) shows a large amount of free fluid in the pelvis tracking up around the liver. Axial CT (below) again shows the mass anterior to the rectum. The mass was felt to be arising from the left adnexa.

The diagnosis was ruptured ectopic pregnancy.