目的 报告陈旧性宫外孕表现为无痛性巨大盆腔包块并影像学误诊1例,并分析该病例影像学误诊的原因.方法 36岁女性,主诉停经71d,阴道流血38 d,加重伴腹胀10 d,妇科检查子宫明显大于孕周,无压痛,人绒毛膜促性腺激素明显增高,CT误诊为滋养细胞肿瘤并左侧髂血管旁淋巴结转移.结果 完善相关准备后行剖腹探查术,术中发现盆腔内一巨大血肿,最大直径达20 cm,行左侧输卵管切除及血肿清除术,术后病检符合输卵管妊娠.结论 陈旧性宫外孕表现为无痛性巨大盆腔包块实属少见,该病例影像学表现特殊,易误诊.%A 36-year old woman was admitted for menolipsis for 71 days and vaginal bleeding for 38 days and aggravation of vaginal bleeding with abdominal distension for 10 days. Gynecological examination revealed marked hysterauxesis without tenderness with a high HCG level. CT examination led to the misdiagnosis of trophoblastic tumor with lymph node metastasis of the left iliac vessels. The patient underwent subsequent laparotomy, and a huge pelvical hematoma with maximum diameter of 20 cm was found, for which left salpingectomy was performed. Pathologic examination of the surgical specimen supported the diagnosis of old tubal pregnancy. This case represents a rare clinical entity of old ectopic pregnancy manifested as a painless huge pelvic mass that can be easily misdiagnosed based on radiographical findings only.
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