Acute spontaneous hematotrachelos following methotrexate treatment of a suspected tubal pregnancy

Hematotrachelos, engorgement of the uterine cervix with retained blood, may represent congenital or acquired conditions. Congenital hematotrachelos may be associated with obstruction distal to the cervix in conditions that include imperforate hymen, complete transverse vaginal septum, and, rarely, agenesis of the vagina with cervical atresia. In contrast, acquired hematotrachelos is usually associated with cervical stenosis as a result of destructive cervical surgeries, including cone biopsy and loop electrosurgical excision procedures performed in the clinical management of cervical dysplasia. We report an unusual case in which the development of acute spontaneous hematotrachelos was sonographically depicted in a multiparous patient during a 5-week period in proximation with intramuscular methotrexate treatment of a suspected tubal pregnancy.