Vaginal bleeding in early pregnancy is a common emergency department complaint. Point-of-care
ultrasound is a useful tool to evaluate for intrauterine ectopic pregnancy. Emergency physicians
performing these studies need to be cognizant of artifacts produced by ultrasound technology, as
they can lead to misdiagnosis. We present two cases where mirror-image artifacts initially led to a
concern for heterotopic pregnancies but were excluded on further imaging.