CASE
A 20-year-old female presented to the emergency department with vaginal bleeding and cramping that began suddenly that same morning. She reported that her last menstrual period was approximately 6 weeks earlier. A point-of-care pregnancy test was positive. On physical examination, dark red blood was pooling in the vaginal vault, the cervical os was closed, and the uterus was enlarged to about 10 weeks fundal height with no palpable adnexal masses. The human chorionic gonadotropin (hCG) level was 110,000 mIU/mL. An ultrasound was obtained (Figure 1). What does the image reveal?