Misdiagnosis of occult heterotopic intramural ectopic pregnancy by two-dimensional ultrasound: Two case reports.

We report two cases of heterotopic intramural ectopic pregnancy (HIMP) following multiple abortions, with lesions located near the uterine fundus or uterine horn. These cases are particularly challenging to diagnose using early two-dimensional transvaginal sonography (TVS). We analyzed multimodal imaging in combination with transabdominal ultrasound (TAS), color Doppler flow imaging (CDFI), three-dimensional TVS, and magnetic resonance imaging (MRI) for early diagnosis and ultimately removed the gestational sac tissue via hysteroscopy. The combination of multimodal imaging techniques, serum β-human chorionic gonadotropin (β-hCG) levels, and clinical vigilance should be considered to prevent the catastrophic consequences of HIMP, particularly when conventional two-dimensional TVS results are equivocal or misleading.