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 Table of Contents  
LETTER TO EDITOR
Year : 2019  |  Volume : 14  |  Issue : 4  |  Page : 438-439

Ring of fire sign in cervical ectopic pregnancy


Department of Radio-Diagnosis, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India

Date of Submission17-Jan-2020
Date of Decision20-Jan-2020
Date of Acceptance25-Jan-2020
Date of Web Publication16-Jul-2020

Correspondence Address:
Dr. Suresh Phatak
Department of Radio-Diagnosis, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha - 442 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_12_20

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How to cite this article:
Varma A, Phatak S, Jain S. Ring of fire sign in cervical ectopic pregnancy. J Datta Meghe Inst Med Sci Univ 2019;14:438-9

How to cite this URL:
Varma A, Phatak S, Jain S. Ring of fire sign in cervical ectopic pregnancy. J Datta Meghe Inst Med Sci Univ [serial online] 2019 [cited 2020 Aug 11];14:438-9. Available from: http://www.journaldmims.com/text.asp?2019/14/4/438/289885



Sir,

Here, we present a case of cervical ectopic pregnancy showing “ring of fire sign.”

When an abnormal pregnancy is suspected due to hormonal tests, a spectrum of abnormalities should be searched for in pelvic ultrasound.[1] The absence of an intrauterine gestational sac is suggestive of an ectopic pregnancy. Up to 35% of ectopic pregnancies do not display any adnexal abnormalities. Possible locations of ectopic pregnancy are as follows – interstitial, tubal, ovarian, cesarean scar, and cervix of uterus.

Cervical pregnancy occurs when implantation within the endocervical canal. It is rare (<1% of ectopic pregnancies) and is mostly associated within vitro fertilization and a history of prior curettage. In a cervical pregnancy, the uterus may be shaped like an hourglass or a figure eight as the fetus expands within the cervix.[2],[3] Cardiac activity below the internal os is highly suggestive of a cervical pregnancy.[3] When a gestational sac is visualized in the region of the cervix, gentle manipulation of the gestational sac is attempted to differentiate a cervical pregnancy from an abortion which in progress. If the sliding sign is seen, i.e., if the transducer probe can manipulate the gestational sac, this confirms that the gestational sac is not adherent to the cervix and excludes cervical pregnancy, which indicates that an abortion is in progress.

The “ring of fire” sign is recognized by peripheral hypervascularity of the hyperechoic ring. The term ring of fire was first used by Pellerito et al.[4] to describe the high-velocity, low-impedance flow surrounding an ectopic adnexal pregnancy [Figure 1].
Figure 1: Sonographic image showing ectopic cervical pregnancy with peripheral vascularity on color Doppler (ring of fire sign)

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Peripheral hypervascularity is a nonspecific finding of the ring of fire sign and may also be seen surrounding a normal maturing follicle or a corpus luteal cyst.[5],[6],[7],[8],[9],[10]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Paspulati RM, Bhatt S, Nour SG. Sonographic evaluation of first-trimester bleeding. Radiol Clin North Am 2004;42:297-314.  Back to cited text no. 1
    
2.
Hofmann HM, Urdl W, Höfler H, Hönigl W, Tamussino K. Cervical pregnancy: Case reports and current concepts in diagnosis and treatment. Arch Gynecol Obstet 1987;241:63-9.  Back to cited text no. 2
    
3.
Kung FT, Lin H, Hsu TY, Chang CY, Huang HW, Huang LY, et al. Differential diagnosis of suspected cervical pregnancy and conservative treatment with the combination of laparoscopy-assisted uterine artery ligation and hysteroscopic endocervical resection. Fertil Steril 2004;81:1642-9.  Back to cited text no. 3
    
4.
Pellerito JS, Taylor KJ, Quedens-Case C, Hammers LW, Scoutt LM, Ramos IM, et al. Ectopic pregnancy: Evaluation with endovaginal color flow imaging. Radiology 1992;183:407-11.  Back to cited text no. 4
    
5.
Durfee SM, Frates MC. Sonographic spectrum of the corpus luteum in early pregnancy: Gray-scale, color, and pulsed Doppler appearance. J Clin Ultrasound 1999;27:55-9.  Back to cited text no. 5
    
6.
Agrawal M, Acharya N, Joshi K, Shrivastava D. Effectiveness of Isosorbide Mononitrate in Cervical Ripening before Induction of Labor in Full-Term Antenatal Patients. J SAFOG 2019;11:96-9. Available from: https://doi.org/10.5005/jp-journals-10006-1668. [Last accessed on 2019 Oct 08].  Back to cited text no. 6
    
7.
Acharya N, Gadge A, Agrawal M, Singh M. Mechanical Cervical Ripening with Foley Catheter Balloon: Rekindling a Forgotten Art. J SAFOG 2018;10:1-4. Available from: https://doi.org/10.5005/jp-journals-10006-1548. [Last accessed on 2019 Oct 08].  Back to cited text no. 7
    
8.
Phatak S, Shrivastav D, Marfani G, Daga S, Madurwar K, Samad S. Transvaginal Sonography and Elastography Evaluation of Ectopic Pregnancy. J Datta Meghe Inst Med Sci Univ 2019;14:86-9. Available from: https://doi.org/10.4103/jdmimsu.jdmimsu_13_19. [Last accessed on 2019 Oct 08].  Back to cited text no. 8
    
9.
Bhriegu R, Agrawal M, Hariharan C. Assessment of Maternal and Perinatal Outcome in Postdated Pregnancy. J Datta Meghe Inst Med Sci Univ 2017;12:35-40. Available from: https://doi.org/10.4103/jdmimsu.jdmimsu_20_17. [Last accessed on 2019 Oct 08].  Back to cited text no. 9
    
10.
Gaikwad KB, Joshi NG, Selkar SP. Study of Nitrosative Stress in Pregnancy Induced Hypertension. J Clin Diagn Res 2017;11:BC06-8. Available from: https://doi.org/10.7860/JCDR/2017/23960.9396. [Last accessed on 2019 Oct 08].  Back to cited text no. 10
    


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