Retroperitoneal hemorrhage presenting as a ruptured ectopic pregnancy

A young woman presented with acute abdominal pain, anemia, and a positive pregnancy test. At surgery a large retroperitoneal hematoma secondary to a ruptured right kidney was found. Pathological examination revealed a hematogenic necrosis of a choriocarcinoma of the kidney. The patient tolerated subsequent chemotherapy with no evidence of recurrent disease after ten months of follow-up care. The diagnosis of choriocarcinoma must always be entertained when a patient presents with a positive pregnancy test and normal pelvic examination.