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Monnet M, Dufrost V, Wahl D, Morel O, Agopiantz M, Zuily S. Epidemiology, natural history, diagnosis, and management of ovarian vein thrombosis: a scoping review. J Thromb Haemost 2024; 22:2991-3003. [PMID: 39209258 DOI: 10.1016/j.jtha.2024.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 07/19/2024] [Accepted: 07/24/2024] [Indexed: 09/04/2024]
Abstract
Ovarian vein thrombosis (OVT) is a rare but potentially serious condition. We conducted a scoping review of published data to provide a better understanding of OVT management. MEDLINE and Cochrane databases were searched. The eligibility criterion was original articles including women with OVT until May 2024. Quantitative data were pooled via Comprehensive Meta-Analysis software (Biostat, Inc). Quality of the primary studies was assessed via the Newcastle‒Ottawa Scale. Out of 1007 identified records, 19 primary studies including 1128 patients were selected. Mean age at OVT diagnosis was 37 years old. Frequency of OVT depended on the clinical situation: cancer (37%) and postpartum (0.06%), including cesarean (0.19%), or persistent fever despite antibiotics (23%). Magnetic resonance imaging was associated with the best diagnostic performance, followed by computed tomography. Pulmonary embolism and extension to the iliac vein, inferior vena cava, or left renal vein occurred in 6.5%, 5.9%, 10.3%, and 9.6% of patients, respectively. Among anticoagulants, low-molecular-height heparin with/without oral anticoagulant was preferred for 3 to 6 months. Among the women tested, thrombophilia was present in 18% of the patients. Recanalization, recurrent thrombosis, or major bleeding occurred in 70%, 8%, and 2% of patients, respectively. The majority of studies had poor evidence. This scoping review provides a comprehensive evaluation of available data. Frequency of OVT depends on the clinical setting. Physicians should be aware of OVT in postpartum women with persistent fever despite the use of antibiotics. OVT belongs to the spectrum of venous thromboembolism and should be considered both in puerperal settings and in cancer patients.
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Affiliation(s)
- Margaux Monnet
- Gynecology and Obstetrics Division, Nancy Regional University Hospital, Nancy, France
| | - Virginie Dufrost
- National Institute of Healthcare and Medical Research, Acute and Chronic Cardiovascular Failure Unit and Nancy Regional University Hospital, Vascular Medicine Division and Regional Competence Center for Rare Auto-Immune Diseases, Université de Lorraine, Nancy, France
| | - Denis Wahl
- National Institute of Healthcare and Medical Research, Acute and Chronic Cardiovascular Failure Unit and Nancy Regional University Hospital, Vascular Medicine Division and Regional Competence Center for Rare Auto-Immune Diseases, Université de Lorraine, Nancy, France
| | - Olivier Morel
- Gynecology and Obstetrics Division, Nancy Regional University Hospital, Nancy, France; Université de Lorraine, National Institute of Healthcare and Medical Research, U1254 Adaptive Diagnostic and Interventional Imaging Unit, Nancy, France
| | - Mikaël Agopiantz
- Gynecology and Obstetrics Division, Nancy Regional University Hospital, Nancy, France; Université de Lorraine, National Institute of Healthcare and Medical Research, U1256 Nutrition-Genetics and Exposure to Environmental Risks Unit, Nancy, France
| | - Stéphane Zuily
- National Institute of Healthcare and Medical Research, Acute and Chronic Cardiovascular Failure Unit and Nancy Regional University Hospital, Vascular Medicine Division and Regional Competence Center for Rare Auto-Immune Diseases, Université de Lorraine, Nancy, France.
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Riva N, Muscat-Baron L, Vassallo C, Ageno W, Rottenstreich A, Sauvé N, Wysokinski WE, Goldberg GL, Salomon O, Labropoulos N, Foulon A, AlSheef M, Gatt A, Calleja-Agius J. Safety and efficacy of anticoagulant treatment in patients with ovarian vein thrombosis: a systematic review and meta-analysis of observational studies. Res Pract Thromb Haemost 2024; 8:102501. [PMID: 39175528 PMCID: PMC11339252 DOI: 10.1016/j.rpth.2024.102501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/24/2024] [Accepted: 06/14/2024] [Indexed: 08/24/2024] Open
Abstract
Background The role of anticoagulation in ovarian vein thrombosis (OVT) is uncertain. Objectives We aimed to evaluate safety and efficacy of anticoagulant treatment in OVT patients. Methods A systematic search was conducted in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases up to April 2024. Eligible studies included randomized controlled trials and observational studies enrolling at least 10 adult patients with objectively diagnosed OVT and treated with any anticoagulants. The protocol was prospectively registered in the International Prospective Register of Systematic Reviews (CRD42021270883). Results We included 17 observational studies (621 anticoagulated and 376 nonanticoagulated OVT patients); 9 studies enrolled mainly pregnancy/puerperium-related OVT. Most patients received heparins alone (45.7%) or proceeded to vitamin K antagonists (39.2%). The average treatment duration was ≤3 months in 8 studies (47.1%), >3 to ≤6 months in 6 studies (35.3%), and >6 months in 3 studies (17.6%). In treated patients, mortality rate was 2.43% (95% CI, 0.54%-5.41%; I2 = 53.8%; 12/406 patients; 13 studies), major bleeding was 1.27% (95% CI, 0.48%-2.38%; I2 = 2.5%; 7/583 patients; 15 studies), recurrent venous thromboembolism (VTE) was 3.49% (95% CI, 1.12%-6.95%; I2 = 63.5%; 22/482 patients; 15 studies), and vessel recanalization was 89.4% (95% CI, 74.6%-98.6%; I2 = 80.6%; 163/184 patients; 8 studies). The rate of recurrent VTE in untreated patients was 8.65% (95% CI, 2.61%-17.35%); however, the difference compared with treated patients was not statistically significant (risk ratio, 0.70; 95% CI, 0.36-1.37). At subgroup analyses, the rates of major bleeding and recurrent VTE were 0.80% (95% CI, 0.0-2%.17%) and 3.81% (95% CI, 0.42%-9.63%) in pregnancy/puerperium-related OVT, respectively, and 1.12% (95% CI, 0.32%-2.34%) and 1.78% (95% CI, 0.62%-3.46%), respectively, when analyzing only full-text studies. Conclusion There is paucity of literature regarding OVT. Our results suggest that anticoagulation is associated with low rates of major bleeding and recurrent VTE.
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Affiliation(s)
- Nicoletta Riva
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Lorna Muscat-Baron
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Carine Vassallo
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Amihai Rottenstreich
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
- Laboratory of Blood and Vascular Biology, Rockefeller University, New York, New York, USA
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nadine Sauvé
- Division of Internal Medicine, Department of Medicine, University of Sherbrooke, Sherbrooke, Québec, Canada
| | | | - Gary L. Goldberg
- Department of Obstetrics and Gynecology, Gynecologic Oncology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health Cancer Institute, New Hyde Park, New York, USA
| | - Ophira Salomon
- Thrombosis Unit, Sheba Medical Center, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Nicos Labropoulos
- Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York, USA
| | - Arthur Foulon
- Obstetrics and Gynecology Department, Amiens University Center, Picardie Jules Verne University, Amiens, France
| | - Mohammed AlSheef
- Internal Medicine and Thrombosis, Medical Specialties Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Alex Gatt
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Jean Calleja-Agius
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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Cheung W, Stegwee S, van Hamont D, Visser J. Postpartum ovarian vein thrombosis with left renal venous infarction after vaginal delivery. BMJ Case Rep 2024; 17:e258877. [PMID: 38442978 PMCID: PMC10916174 DOI: 10.1136/bcr-2023-258877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
A primipara in her late 20s presented with abdominal pain and pain in the left flank 14 days after a ventouse delivery. She was treated with antibiotics, antiemetics and analgesics with the initial differential diagnosis of cystitis, pyelonephritis or nephrolithiasis. Despite the treatment, the patient experienced increased colic pain and nausea. An ultrasound showed an enlarged left kidney, suggesting pyelonephritis, and thereby, the antibiotic treatment was adjusted accordingly. Despite additional pain medication, pain relief could not be achieved. The diagnosis of ovarian venous thrombosis was considered, and an abdominal CT scan confirmed the diagnosis. The patient was treated with anticoagulant therapy. Hypercoagulability work-up revealed a heterozygous mutation of the Factor V Leiden. Our patient awaits a haematologic follow-up.
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Affiliation(s)
- Wingman Cheung
- Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, The Netherlands
| | - Sanne Stegwee
- Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, The Netherlands
- Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Dennis van Hamont
- Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, The Netherlands
| | - Jantien Visser
- Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, The Netherlands
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Muscat-Baron L, Borg AL, Attard LM, Gatt A, Riva N. Cancer-Associated Abdominal Vein Thrombosis. Cancers (Basel) 2023; 15:5293. [PMID: 37958466 PMCID: PMC10649304 DOI: 10.3390/cancers15215293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
Cancer is associated with an increased risk of developing venous thromboembolism, due to its direct influence on the three pillars of Virchow's triad (e.g., compression on the blood vessels by the tumour, blood vessels invasion, and cytokine release), together with the effect of exogenous factors (such as chemotherapy, radiotherapy, surgery). In cancer patients, the risk of thrombosis at unusual sites, such as splanchnic, ovarian and renal vein thrombosis, is also increased. Abdominal vein thromboses are frequently incidental findings on abdominal imaging performed as part of the diagnostic/staging workup or the follow-up care of malignancies. There is little evidence on the management of unusual site venous thromboembolism in cancer patients since there are only a few specific recommendations; thus, the management follows the general principles of the treatment of cancer-associated deep vein thrombosis and pulmonary embolism. This narrative review summarises the latest evidence on cancer-associated abdominal vein thrombosis, i.e., thrombosis of the splanchnic, ovarian and renal veins.
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Affiliation(s)
- Lorna Muscat-Baron
- Medical School, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta; (L.M.-B.); (A.L.B.); (L.M.A.)
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta;
| | - Amber Leigh Borg
- Medical School, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta; (L.M.-B.); (A.L.B.); (L.M.A.)
| | - Laura Maria Attard
- Medical School, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta; (L.M.-B.); (A.L.B.); (L.M.A.)
| | - Alex Gatt
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta;
| | - Nicoletta Riva
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta;
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Hirata Y, Kawamura H, Kato M, Ezaka Y, Yoshida Y. Rectus Sheath Hematoma Triggered by Post-cesarean Anticoagulant Therapy for Intraoperative Acute Pulmonary Thromboembolism: A Case Report. Cureus 2023; 15:e49034. [PMID: 38116345 PMCID: PMC10728606 DOI: 10.7759/cureus.49034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/21/2023] Open
Abstract
Anticoagulant therapy is essential for the prevention or treatment of peripartum venous thromboembolism (VTE). Administration of a therapeutic dose of anticoagulant immediately after cesarean section may result in the formation of a rectus sheath hematoma. A 32-year-old Japanese woman delivered twin neonates by cesarean section at 37+5 weeks of gestation. After the removal of the placenta, the patient suddenly complained of left anterior chest pain and dyspnea with hypotension and desaturation, requiring the administration of oxygen and vasopressors. Postoperative contrast-enhanced computed tomography (CT) revealed pulmonary embolism and massive right ovarian vein thrombosis (OVT). An inferior vena cava filter was placed and continuous intravenous heparin was started. A rectus sheath hematoma was noted on postoperative day 2 (POD 2). On POD 5, heparin administration was temporarily discontinued because of an enlarged rectus sheath hematoma. Approximately 24 hours later, the hemoglobin level recovered, and heparin administration was resumed. No further expansion of the hematoma was observed. When a rectus sheath hematoma is formed due to treatment with a therapeutic dose of anticoagulant immediately after cesarean section for peripartum VTE, temporary suspension of anticoagulant administration is reasonable to prevent further expansion of the hematoma without fatal complication.
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Affiliation(s)
- Yuki Hirata
- Obstetrics and Gynecology, University of Fukui, Fukui, JPN
| | | | - Masataka Kato
- Obstetrics and Gynecology, University of Fukui, Fukui, JPN
| | - Yukie Ezaka
- Obstetrics and Gynecology, University of Fukui, Fukui, JPN
| | - Yoshio Yoshida
- Obstetrics and Gynecology, University of Fukui, Fukui, JPN
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Masselli G, Bonito G, Gigli S, Ricci P. Imaging of Acute Abdominopelvic Pain in Pregnancy and Puerperium-Part II: Non-Obstetric Complications. Diagnostics (Basel) 2023; 13:2909. [PMID: 37761275 PMCID: PMC10528125 DOI: 10.3390/diagnostics13182909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/28/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Emergency imaging in pregnancy and puerperium poses unique challenges both for clinicians and radiologists, requiring timely and accurate diagnosis. Delay in treatment may result in poor outcomes for both the patient and the foetus. Pregnant and puerperal patients may present in the emergency setting with acute abdominopelvic pain for various complications that can be broadly classified into obstetric and non-obstetric related diseases. Ultrasonography (US) is the primary diagnostic imaging test; however, it may be limited due to the patient's body habitus and the overlapping of bowel loops. Computed tomography (CT) carries exposure to ionising radiation to the foetus, but may be necessary in selected cases. Magnetic resonance imaging (MRI) is a valuable complement to US in the determination of the etiology of acute abdominal pain and can be used in most settings, allowing for the identification of a broad spectrum of pathologies with a limited protocol of sequences. In this second section, we review the common non-obstetric causes for acute abdominopelvic pain in pregnancy and post partum, offering a practical approach for diagnosis and pointing out the role of imaging methods (US, MRI, CT) with the respective imaging findings.
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Affiliation(s)
- Gabriele Masselli
- Department of Emergency Radiology-Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.M.); (P.R.)
| | - Giacomo Bonito
- Department of Emergency Radiology-Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.M.); (P.R.)
| | - Silvia Gigli
- Department of Diagnostic Imaging, Sandro Pertini Hospital, Via dei Monti Tiburtini 385, 00157 Rome, Italy;
| | - Paolo Ricci
- Department of Emergency Radiology-Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.M.); (P.R.)
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
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Gao Q, Xiong J, Jiang H. Pharmacologic treatment of a postpartum ovarian vein thrombosis: Case report. Medicine (Baltimore) 2023; 102:e34711. [PMID: 37565858 PMCID: PMC10419415 DOI: 10.1097/md.0000000000034711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/21/2023] [Indexed: 08/12/2023] Open
Abstract
INTRODUCTION Postpartum ovarian vein thrombosis (POVT) is a rare disease, and could cause severe complications if ignored. We report a case of POVT, including the patient clinical features, diagnostic methods, treatment, and follow-up results. CASE PRESENTATION A 30-year-old Asian woman was admitted to our hospital because of spontaneous abortion. After the miscarriage, she presented with fever and right lower abdominal pain. A physical examination revealed abdominal tenderness in the right lower quadrant with a palpable mass. Laboratory tests showed leucocytosis and elevated C-reactive protein. Abdominal ultrasound (US) and computed tomography revealed right ovarian vein thrombosis (OVT). The patient was treated with systemic anticoagulation and antibiotics and was discharged 22 days later on a regimen of an oral anticoagulant. 1.5 months after discharge, an US with a color Doppler examination showed no OVT. CONCLUSION A high index of suspicion is required in cases of abdominal pain and fever after delivery, especially if unresponsive to antibiotics. It should be differentiated from acute appendicitis, accessory abscess, endometritis, ovarian torsion, and other acute abdominal diseases. For a POVT case with a definite diagnosis, drug treatment may be effective enough.
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Affiliation(s)
- Qianqian Gao
- Departments of Obstetrics, Weifang People’s Hospital, First Affiliated Hospital of Weifang Medical College, Weifang, Shandong, China
| | - Jinqiu Xiong
- Departments of General Surgery, Weifang People’s Hospital, First Affiliated Hospital of Weifang Medical College, Weifang, Shandong, China
| | - Hong Jiang
- Departments of Obstetrics, Weifang People’s Hospital, First Affiliated Hospital of Weifang Medical College, Weifang, Shandong, China
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Zhu HD, Shen W, Wu HL, Sang X, Chen Y, Geng LS, Zhou T. Postpartum ovarian vein thrombosis after cesarean section and vaginal delivery: Two case reports. World J Clin Cases 2023; 11:3877-3884. [PMID: 37383122 PMCID: PMC10294170 DOI: 10.12998/wjcc.v11.i16.3877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/18/2023] [Accepted: 05/06/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Postpartum ovarian vein thrombosis (POVT) is a rare puerperal complication. It is easily missed or misdiagnosed due to its insidious onset and lack of specific clinical symptoms and signs. This paper reports two patients who developed right ovarian vein thrombosis after cesarean section and vaginal delivery, respectively.
CASE SUMMARY Case 1 was a 32-year-old female who underwent a cesarean section in labor at 40 wk of gestation due to fetal distress. The patient was persistently febrile after the operation and escalated antibiotic treatment was ineffective. POVT was diagnosed by abdominal computed tomography (CT) and was treated by increasing the dose of low molecular weight heparin (LMWH). Case 2 was a 21-year-old female with a spontaneous vaginal delivery at 39 wk of gestation. The patient developed fever and abdominal pain 3 days after delivery. POVT was promptly identified by abdominal CT, and the condition was quickly controlled after treatment with LMWH and antibiotics.
CONCLUSION These two cases occurred after cesarean section and vaginal delivery, respectively. The diagnosis was mainly based on imaging examination due to the unspecific clinical symptoms and signs, the CT scan provided an especially high diagnostic value. Comparing these two cases, escalating antibiotics alone did not provide significant therapeutic benefit, but the early escalation of anticoagulant dosage seemed to shorten the disease course. Therefore, early diagnosis by CT followed by aggressive anticoagulation might have a positive effect on improving the prognosis of the disease.
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Affiliation(s)
- Hong-Dan Zhu
- Department of Obstetrics and Gynecology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou 311200, Zhejiang Province, China
| | - Wei Shen
- Department of Obstetrics and Gynecology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou 311200, Zhejiang Province, China
| | - He-Li Wu
- Department of Obstetrics and Gynecology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou 311200, Zhejiang Province, China
| | - Xia Sang
- Department of Obstetrics and Gynecology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou 311200, Zhejiang Province, China
| | - Yun Chen
- Department of Obstetrics and Gynecology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou 311200, Zhejiang Province, China
| | - Li-Shu Geng
- Department of Obstetrics and Gynecology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou 311200, Zhejiang Province, China
| | - Tao Zhou
- Department of Obstetrics and Gynecology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou 311200, Zhejiang Province, China
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Akbari EA, Majdalawi R, Harb DK, Hazari K, Abdelkareem W, Ammar A. Postpartum Septic Pelvic Thrombophlebitis in a Tertiary Maternity Hospital in Dubai, UAE. Cureus 2023; 15:e36452. [PMID: 37090405 PMCID: PMC10116435 DOI: 10.7759/cureus.36452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/25/2023] Open
Abstract
Septic pelvic thrombophlebitis (SPT) is a well-known condition, yet it remains a rare postpartum complication. It can be divided into two types: deep septic pelvic thrombophlebitis (DSPT) and ovarian vein thrombosis (OVT). In this case series, we present three cases diagnosed with ovarian vein thrombosis that were managed in our tertiary care hospital, Latifa Women and Children Hospital (LWCH), in Dubai, UAE. It is a 440-bed public tertiary care center that specializes in maternal and neonatal services, with a range of 3500 to 4000 deliveries per year. The three cases represent the total number diagnosed with this condition in the period between 2018 and 2022 among the total obstetric population during this period. The three cases developed a fever in the postpartum period, which for several days did not respond to the standard antibiotics used for endometritis. Two cases were following a cesarean section, and the third case was following vaginal delivery complicated with severe postpartum hemorrhage and hysterectomy. The clinical suspicion and awareness of the condition paved the way to reach the proper diagnosis and initiate the therapeutic dose of anticoagulants, along with broad-spectrum antibiotics, in a timely manner. The prompt diagnosis with early intervention led to optimal patient outcomes and prevented the morbidity and mortality associated with this condition.
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Affiliation(s)
- Elham A Akbari
- Obstetrics and Gynecology, Latifa Hospital - Dubai Academic Health Corporation, Dubai, ARE
| | - Rawan Majdalawi
- Obstetrics and Gynecology, Latifa Hospital - Dubai Academic Health Corporation, Dubai, ARE
| | - Deemah K Harb
- Internal Medicine, Latifa Hospital - Dubai Academic Health Corporation, Dubai, ARE
| | - Komal Hazari
- Internal Medicine, Latifa Hospital - Dubai Academic Health Corporation, Dubai, ARE
| | - Widad Abdelkareem
- Internal Medicine, Latifa Hospital - Dubai Academic Health Corporation, Dubai, ARE
| | - Abeir Ammar
- Obstetrics and Gynaecology, Latifa Hospital - Dubai Academic Health Corporation, Dubai, ARE
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Wang JJ, Hui CC, Ji YD, Xu W. Computed tomography diagnosed left ovarian venous thrombophlebitis after vaginal delivery: A case report. World J Clin Cases 2023; 11:896-902. [PMID: 36818636 PMCID: PMC9928707 DOI: 10.12998/wjcc.v11.i4.896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/21/2022] [Accepted: 01/12/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Postpartum ovarian vein thrombophlebitis (POVT) is a rare but serious postpartum complication that affects mostly postpartum women. A high index of suspicion is required when faced with sudden postpartum abdominal pain.
CASE SUMMARY A 25-year-old healthy woman who accepted a vaginal delivery procedure suffered fever (temperature 39.6℃) one day after delivery, accompanied with left lower abdominal pain. Physical examination indicated mild tenderness in the left lower abdomen, accompanied with rebound pain. The patient was confirmed to have left ovarian venous thrombosis with inflammation after receiving a multi-detector row computed tomography scan.
CONCLUSION POVT is a rare and dangerous postpartum complication. A high index of suspicion is required for the occurrence of ovarian venous thrombosis when faced with postpartum abdominal pain and fever. Early application of Doppler ultrasound, computed tomography, magnetic resonance imaging and other auxiliary examinations is conducive to timely and accurate diagnosis of POVT, thus reducing maternal mortality.
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Affiliation(s)
- Jin-Jin Wang
- Department of Radiology, The Ninth People’s Hospital of Suzhou City, Suzhou 215200, Jiangsu Province, China
| | - Chu-Chu Hui
- Department of Ultrasound, The Ninth People’s Hospital of Suzhou City, Suzhou 215200, Jiangsu Province, China
| | - Yi-Ding Ji
- Department of Radiology, The Ninth People’s Hospital of Suzhou City, Suzhou 215200, Jiangsu Province, China
| | - Wei Xu
- Department of Emergency Medicine, The Ninth People’s Hospital of Suzhou City, Suzhou 215200, Jiangsu Province, China
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[Postpartum ovarian vein thrombophlebitis: diagnosis, treatment and follow-up. Retrospective study over 10 years]. Rev Med Interne 2022; 43:462-469. [PMID: 35879134 DOI: 10.1016/j.revmed.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/03/2022] [Accepted: 07/07/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Postpartum ovarian vein thrombosis (POVT) is a rare but serious postpartum complication that can be life-threatening due to its embolic and septic risks. The clinical and paraclinical diagnosis is difficult because of the non-specific signs and the absence of a gold standard for imaging. There is no consensus in the literature on the treatment and follow-up of these patients. The primary objective was to specify the clinical and paraclinical signs suggestive of POVT in order to improve the diagnostic delay. The secondary objectives were to describe the extent of POVT and the proposed immediate therapeutic management. METHODS This was a 10-year retrospective study in a type III maternity hospital, from January 2010 to December 2019, where all patients with an imaging-confirmed diagnosis of POVT were included. We analysed the clinical and paraclinical data and the follow-up of the patients. RESULTS We included 9 patients with a diagnostic confirmation by imaging. The mean time from first symptoms to diagnosis was 3.3 days (±3.5 days), and only 2 patients (22.2 %) had been diagnosed with POVT before imaging. All patients received curative anticoagulation and 77.8 % (n=7) received antibiotic therapy for POVT. Two patients had a complicated form, 1 with a pulmonary embolism and 1 with a urinary tract compression requiring a urinary diversion with a double J catheter. Five patients (55.6 %) had a thrombophilia check-up. CONCLUSION The diagnosis of POVT is difficult and needs to be evoked in front of a painful symptomatology or a fever in postpartum. It can be made by ultrasound, but the injected CT scan specifying the specific search for a POVT remains the imaging examination of choice in order to confirm the diagnosis and eliminate differential diagnoses. Under curative anticoagulation and broad-spectrum antibiotic therapy, the clinical course is generally very favourable. A consultation with an internist makes it possible to define instructions for a subsequent pregnancy.
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Komagamine J, Takarada C, Yabuki T. Ovarian Vein Thrombosis as an Uncommon Cause of Postpartum Fever: A Case Report. Cureus 2022; 14:e22504. [PMID: 35371776 PMCID: PMC8947820 DOI: 10.7759/cureus.22504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/05/2022] Open
Abstract
Postpartum ovarian vein thrombosis (POVT) is an uncommon cause of postpartum fever. Because POVT is sometimes complicated by pulmonary embolism, preventing diagnostic delay is critical. Nonetheless, the diagnostic delay of POVT is common due to its rarity. Antibiotics along with anticoagulants are recommended as the standard therapy for POVT, but this recommendation is based on older, low-quality literature. Here, we present a case of POVT, presenting with a persistent postpartum fever, which was treated by anticoagulants without antibiotics. Our case highlights the importance of awareness of POVT as a differential diagnosis and the need for studies to investigate the role of antibiotics in POVT.
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13
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Markus J, van der Weiden RM. Laparoscopic diagnosis of idiopathic left ovarian vein thrombosis in a 27-year-old woman. JRSM Open 2022; 13:20542704221074150. [PMID: 35096407 PMCID: PMC8793118 DOI: 10.1177/20542704221074150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Idiopathic left ovarian vein thrombosis was diagnosed in a 27-year-old woman at the time of a diagnostic laparoscopy performed because of a suspected ovarian torsion. The diagnosis was confirmed by abdominal computed tomography scanning. Subsequent magnetic resonance imaging showed no signs of an abdominal or pelvic mass nor enlarged lymph nodes. The patient was treated with systemic anticoagulation therapy for 3 months and made a good recovery. During follow-up it became clear that the patient was already diagnosed with familial hypercholesterolemia before the occurrence of the ovarian vein thrombosis. It remains unclear if familial hypercholesterolemia played a role in the occurrence of ovarian vein thrombosis in our patient.
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Affiliation(s)
- Jasper Markus
- Franciscus Gasthuis & Vlietland, Department of Gynecology & Obstetrics, Rotterdam, Netherlands
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14
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Postpartum ovarian vein thrombosis. CASE REPORTS IN PERINATAL MEDICINE 2021. [DOI: 10.1515/crpm-2021-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
Postpartum ovarian vein thrombosis (POVT) is a rare pathology that can lead to severe complications such as sepsis, extension of the thrombus leading to organ failure, and pulmonary embolism. It therefore requires early recognition and prompt treatment.
Case presentation
A patient with right POVT presented four days after delivery with acute right-sided abdominal pain and fever. Appendicitis was initially considered, before an abdominal-pelvic computed tomography raised the suspicion of POVT, subsequently confirmed through transabdominal ultrasound. Antibiotics and anticoagulation were initiated, with rapid clinical improvement and complete resolution of the thrombus three months later.
Conclusions
Diagnosing POVT is challenging as it clinically mimics other more frequent conditions. It is rare but life-threatening and should be considered in all females presenting with abdominal pain and fever in the postpartum period.
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15
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Allain Wouterlood M, Malhamé I, Lévesque K, Dayan N, Mahone M, Côté AM, Cumyn A, Malick M, Sauvé N. Pregnancy-associated pelvic vein thrombosis: Insights from a multicenter case series. J Thromb Haemost 2021; 19:1926-1931. [PMID: 33834605 DOI: 10.1111/jth.15333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/09/2021] [Accepted: 03/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pelvic vein thrombosis (PVT) is a rare complication of pregnancy that can lead to life-threatening complications, such as pulmonary embolism (PE). OBJECTIVE To describe characteristics of PVT and its treatment in pregnancy in the province of Quebec, Canada. PATIENTS/METHODS We developed a province-wide case series of PVT in pregnancy including four tertiary care centers and the Registry of Rare Diseases of the Groupe d'Étude en Médecine Obstétricale du Québec. Using diagnostic codes, we included cases with confirmed PVT on imaging during pregnancy or within 6 weeks postpartum from July 2003 to June 2018. RESULTS A total of 47 cases were identified. PVT diagnosis was generally made in the early postpartum period (median of 9 [interquartile range (IQR) 4.5-12] days postpartum). Most PVT (94%) included in this series were symptomatic. Women presented primarily with abdominal pain (77%) and fever (55%), often prolonged despite antibiotics (mean 4.45 ± 2.39 days, with 39% having fever for more than 5 days). The most common risk factor was surgery (57%) and peripartum infections (54%). Thirty-eight (83%) women received antibiotics and 41 (89%) were anticoagulated. Three cases of PE (7%) occurred concomitantly, 11% of women required intensive care, and 19% had inferior vena cava (IVC) clot extension. The episode resulted in prolonged hospitalization (median 6 [IQR 3-10.75] days), with 48% being hospitalized more than 7 days. CONCLUSION Symptomatic PVT has significant clinical implications with prolonged fever and risks of extension in the IVC and PE, leading to prolonged hospitalization including in the intensive care unit. Therapeutic anticoagulation and antibiotics, when infection is documented, should be considered for management.
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Affiliation(s)
| | - Isabelle Malhamé
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kateri Lévesque
- Department of Medicine, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Natalie Dayan
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Michèle Mahone
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Anne-Marie Côté
- Department of Medicine, Centre Hospitalier de l'Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Annabelle Cumyn
- Department of Medicine, Centre Hospitalier de l'Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mandy Malick
- Department of Medicine, Centre Hospitalier de l'Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Nadine Sauvé
- Department of Medicine, Centre Hospitalier de l'Université de Sherbrooke, Sherbrooke, Quebec, Canada
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16
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Li W, Cao S, Zhu R, Chen X. Idiopathic ovarian vein thrombosis causing pulmonary embolism: case report and literature review. J Int Med Res 2021; 49:3000605211010649. [PMID: 34187208 PMCID: PMC8258764 DOI: 10.1177/03000605211010649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Ovarian vein thrombosis (OVT) is a rare medical disorder, which is most often found in the immediate postpartum period. OVT is rarely considered idiopathic. We report a case of idiopathic OVT with pulmonary embolism in a 33-year-old woman who presented with abdominal pain. Computed tomography and postoperative pathology confirmed the diagnosis of idiopathic OVT. To date, only 12 cases of idiopathic OVT have been reported. In this case report, we present a summary of these cases and a review of literature regarding management of idiopathic OVT.
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Affiliation(s)
- Wenrui Li
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Wenrui Li, Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong’an Road, Beijing 100050, China.
| | - Saisai Cao
- Department of Plastic Surgery, Peking University People’s Hospital, Beijing, China
| | - Renming Zhu
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xueming Chen
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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17
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Gillams K, Jones P, Iacovou J, Hawary A. Renal obstruction caused by postpartum ovarian vein thrombosis. Br J Hosp Med (Lond) 2021; 82:1-2. [PMID: 34191555 DOI: 10.12968/hmed.2020.0482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kathryn Gillams
- Urology Department, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Patrick Jones
- Urology Department, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - John Iacovou
- Urology Department, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Amr Hawary
- Urology Department, Great Western Hospitals NHS Foundation Trust, Swindon, UK
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18
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DeBoer RE, Oladunjoye OO, Herb R. Right Ovarian Vein Thrombosis in the Setting of COVID-19 Infection. Cureus 2021; 13:e12796. [PMID: 33628665 PMCID: PMC7893676 DOI: 10.7759/cureus.12796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2021] [Indexed: 11/05/2022] Open
Abstract
Ovarian vein thrombosis is a rare condition associated with the postpartum state, pelvic disease, gynecological surgeries, and other thrombophilic states. We present the first reported case of right ovarian vein thrombosis (OVT) in the setting of Coronavirus disease 2019 (COVID-19) unrelated to pregnancy, pelvic disease, or surgery. This case highlights the breadth of the hypercoagulable state induced by COVID-19. We also put forward the use of novel oral anticoagulants in the case of OVT.
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Affiliation(s)
| | | | - Ronald Herb
- Internal Medicine, Reading Hospital Tower Health, Reading, USA
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19
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Abstract
Ovarian vein thrombosis (OVT) is a rare type of venous thromboembolism. The most common risk factors for OVT include pregnancy, oral contraceptives, malignancies, recent surgery, and pelvic infections; however, in 4 to 16% of cases, it can be classified as idiopathic. Most of the available information regards pregnancy-related OVT, which has been reported to complicate 0.01 to 0.18% of pregnancies and to peak around 2 to 6 days after delivery or miscarriage/abortion. The right ovarian vein is more frequently involved (70-80% of cases). Clinical features of OVT include abdominal pain and tenderness, fever, and gastrointestinal symptoms. The most typical finding is the presence of a palpable abdominal mass, although reported in only 46% of cases. OVT can be the cause of puerperal fever in approximately a third of women. Ultrasound Doppler is the first-line imaging, because of its safety, low cost, and wide availability. However, the ovarian veins are difficult to visualize in the presence of bowel meteorism or obesity. Thus, computed tomography or magnetic resonance imaging is often required to confirm the presence and extension of the thrombosis. In oncological patients, OVT is often an incidental finding at abdominal imaging. Mortality related to OVT is nowadays low due to the combination treatment of parenteral broad-spectrum antibiotics (until at least 48 hours after fever resolution) and anticoagulation (low-molecular-weight heparin, vitamin K antagonists, or direct oral anticoagulants). Anticoagulant treatment duration of 3 to 6 months has been recommended for postpartum OVT, while no anticoagulation has been suggested for incidentally detected cancer-associated OVT.
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Affiliation(s)
- Nicoletta Riva
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.,Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Jean Calleja-Agius
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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20
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Treatment of unusual thrombotic manifestations. Blood 2020; 135:326-334. [PMID: 31917405 DOI: 10.1182/blood.2019000918] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/28/2019] [Indexed: 12/21/2022] Open
Abstract
Venous thrombosis rarely occurs at unusual sites such as cerebral, splanchnic, upper-extremity, renal, ovarian, or retinal veins. Clinical features, symptoms, and risk factors of rare thrombotic manifestations are heterogeneous and in large part differ from those typical of the commonest manifestations of venous thrombosis at the lower extremities. The therapeutic approach also varies widely according to the affected site, whether cerebral, abdominal, or extraabdominal. To date, anticoagulant therapy for thrombosis at unusual sites is generally accepted, but the optimal therapeutic approach remains challenging. This review is focused on the treatment of unusual thrombotic manifestations as reported in the most recent guidelines and according to the updated scientific literature.
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21
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Roberts CS, Dunn MA. Postpartum inferior vena cava thrombosis treated by endovascular suction thrombectomy utilizing veno-venous extracorporeal circulation. Proc (Bayl Univ Med Cent) 2019; 32:554-556. [PMID: 31656417 DOI: 10.1080/08998280.2019.1629206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022] Open
Abstract
Vena cava thrombosis arising from ovarian vein thrombosis in the postpartum period is a challenging clinical problem with limited treatment options. We describe the first reported use of veno-venous extracorporeal circulation and endovascular suction thrombectomy to treat inferior vena cava thrombosis in a postpartum patient.
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Affiliation(s)
- Charles S Roberts
- Department of Cardiac Surgery, Baylor University Medical CenterDallasTexas
| | - Matthew A Dunn
- Department of Radiology, Trident Medical CenterCharlestonSouth Carolina
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22
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Abrantes J, Teixeira E, Gomes F, Fernandes C. Postpartum ovarian vein thrombosis and venous anatomical variation. BMJ Case Rep 2019; 12:12/6/e228399. [PMID: 31229971 DOI: 10.1136/bcr-2018-228399] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
A 34-year-old multipara presented 72 hours postpartum with acute right-sided abdominal pain. The investigation revealed mild leucocytosis with positive D-dimer and elevated C reactive protein. Abdominal ultrasound and abdominopelvic CT demonstrated an enlarged right ovarian vein with endoluminal thrombus, representing postpartum ovarian vein thrombosis. The patient became asymptomatic 48 hours after starting broad-spectrum antibiotic treatment and anticoagulant therapy. She completed the treatment in ambulatory regimen and control abdominopelvic CT imaging was performed and revealed a duplicated right ovarian vein and a small residual subacute thrombus in the lumen of the distal right ovarian vein. The patient remained asymptomatic in the clinical follow-up.
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Affiliation(s)
- João Abrantes
- Centro Hospitalar Barreiro Montijo EPE, Barreiro, Portugal
| | | | - Fernanda Gomes
- Centro Hospitalar Barreiro Montijo EPE, Barreiro, Portugal
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23
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Fishel Bartal M, Sibai BM, Ben-Mayor Bashi T, Dangot A, Schushan Eisen I, Dulitzki M, Inbar Y, Mazaki-Tovi S, Hendler I. Abdominal computed tomography (CT) scan in the evaluation of refractory puerperal fever: impact on management . J Matern Fetal Neonatal Med 2018;33:577-582. [PMID: 29973085 DOI: 10.1080/14767058.2018.1497603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Introduction: Computed tomography (CT) imaging should be employed judiciously, given its cost, use of intravenous contrast, and ionizing radiation. The aim of this study was to determine the clinical benefit of a CT scan in the evaluation of refractory puerperal fever and to identify the appropriate candidates for its use.Methods: This was a retrospective cohort study conducted in a single tertiary care center between January 2007 to April 2017. Indications for CT scan were refractory postpartum fever of ≥3 days and/or ultrasound findings suggesting complex abdominal fluid collection. Primary outcome was defined as a change in the mode of treatment due to the CT findings. In addition, a multivariate analysis of risk factors for puerperal fever was performed to identify patients who would benefit from the CT scan evaluation.Results: There were 520 women that underwent an abdominal and pelvic CT scan during the study period, 238 (45.7%) met inclusion criteria, 94 (39.5%) had a normal CT scan, and 144 (60.5%) had abnormal findings including 32 (13.4%) cases with pelvic thrombophlebitis and 112 (47%) cases with pelvic fluid collections. Results of the CT changed clinical management in 93 (39.0%) patients, including: switching antibiotics in 24 (10%) patients, adding low molecular weight heparin for 28 (11.8%) patients, and surgical intervention (laparotomy or drainage insertion) in 41 (17.2%) patients. In the regression model, we didn't find any significant risk factors associated with treatment change following the CT scan.Conclusions: Abdominal and pelvic CT scan in women with refractory puerperal fever has a high clinical yield and lead to a change in management in a substantial number of patients.
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Affiliation(s)
- Michal Fishel Bartal
- Department of Obstetrics, Gynecology and Reproductive sciences, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Baha M Sibai
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal Fetal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UT Health), Houston, TX, USA
| | - Tali Ben-Mayor Bashi
- Department of Obstetrics, Gynecology and Reproductive sciences, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ayelet Dangot
- Department of Obstetrics, Gynecology and Reproductive sciences, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Irit Schushan Eisen
- Department of Neonatology, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Mordechai Dulitzki
- Department of Obstetrics, Gynecology and Reproductive sciences, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Yael Inbar
- Diagnostic Radiology, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shali Mazaki-Tovi
- Department of Obstetrics, Gynecology and Reproductive sciences, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Israel Hendler
- Department of Obstetrics, Gynecology and Reproductive sciences, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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24
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Abstract
: Ovarian vein thrombosis (OVT) remains poorly understood with no consensus regarding its importance or treatment. In this retrospective study, we investigated the clinical features, risk factors, treatment patterns, and prognosis of patients with OVT, including venous thromboembolism (VTE) recurrences. Adult patients who presented to our medical center with an identifiable diagnosis of OVT over a 10-year period were included in this retrospective observational study. Individual patient charts were reviewed to collect baseline and outcomes data. We identified 223 women with OVT. Median follow-up was 857 days. Only 36.6% presented with abdominal pain and 61.4% reported a history of gynecologic surgery. Overall, right or left OVT incidence was similar (44.6 and 41.4%, respectively) but peripartum patients were more likely to have right OVT (60.0%, P = 0.03). VTE recurred in 22 (9.9%) women, all of which were remote from the OVT and there were no recurrences in peripartum patients. Mean (± SD) time to recurrence was 409 (± 421) days. Only 7.6% of OVT patients were anticoagulated for OVT; these women had a 38% reduction in VTE recurrence but because of low numbers, this was not statistically significant. VTE recurrence after OVT was associated with greater mortality in all patients, including patients with cancer. OVT is associated with an increased rate of non-OVT recurrence. Peripartum OVT patients appear to constitute a different patient population as they were younger, exhibited different risk factors, and had no increased incidence of recurrence. Although only a minority of patients with OVT was anticoagulated, this group had a reduction in VTE recurrence. A prospective study is needed to determine the utility of anticoagulation for women with OVT.
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25
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Bannow BTS, Skeith L. Diagnosis and management of postpartum ovarian vein thrombosis. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2017; 2017:168-171. [PMID: 29222252 PMCID: PMC6142588 DOI: 10.1182/asheducation-2017.1.168] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
A 26-year-old woman experienced persistent fever (39.5°C), chills, and right-lower-quadrant tenderness 3 days after caesarean delivery. A computed tomography (CT) scan of the abdomen and pelvis with contrast revealed enlargement of her right ovarian vein with an associated intraluminal filling defect. What is the best treatment of this patient?
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Affiliation(s)
| | - Leslie Skeith
- Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; and
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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26
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Rottenstreich A, Da'as N, Kleinstern G, Spectre G, Amsalem H, Kalish Y. Pregnancy and non-pregnancy related ovarian vein thrombosis: Clinical course and outcome. Thromb Res 2016; 146:84-88. [PMID: 27614189 DOI: 10.1016/j.thromres.2016.09.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/17/2016] [Accepted: 09/01/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To collect and summarize demographic, clinical, laboratory and radiologic characteristics, as well as management and follow-up data, of patients diagnosed with ovarian vein thrombosis. METHODS A multicenter retrospective review of all patients diagnosed with ovarian vein thrombosis between January 2000 and May 2015 at three university hospitals. RESULTS Data of 74 women were analyzed. Mean age was 31±9years. Sixty (81.1%) cases were pregnancy-related. The presence of at least one underlying risk factor (most commonly active infection or surgery) was more common among pregnancy than non-pregnancy related cases (61.7% vs. 14.3%, P=0.002). Anticoagulation therapy was administered in 98.6% of patients and adjunctive antibiotic therapy in 39 (52.7%). At a median follow-up of 40±38months, only one recurrent thrombotic event was observed, and no events of death. Median duration of anticoagulation treatment tended to be longer among patients with non-pregnancy related OVT (6months [3-14] vs. 3months [3-6], P=0.1). Thrombophilic evaluation detected any thrombophilic risk factor in 12 (20%) and 6 (42.9%) women with pregnancy and non-pregnancy related ovarian vein thrombosis, respectively (P=0.09). CONCLUSION Pregnancy-related ovarian vein thrombosis is characterized by a provoked nature and a high rate of resolution after short term treatment. Treatment of three months duration of anticoagulation following this condition appeared in this study to be safe, with no recurrences encountered during a median follow up of 40months. Thrombophilia seems to have an important role in ovarian vein thrombosis and should be evaluated in non-pregnancy related cases.
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Affiliation(s)
- Amihai Rottenstreich
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Nael Da'as
- Internal Medicine D, Hematology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Geffen Kleinstern
- Braun School of Public Health and Community Medicine, Faculty of Medicine of the Hebrew University and Hadassah, Jerusalem, Israel
| | - Galia Spectre
- Department of Hematology, Coagulation Unit, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Hagai Amsalem
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yosef Kalish
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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27
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Lerouge J, Sanguin S, Gondry J, Sergent F. Prise en charge de la thrombose veineuse ovarienne du post-partum. L’expérience du CHU d’Amiens. ACTA ACUST UNITED AC 2016; 44:88-95. [DOI: 10.1016/j.gyobfe.2015.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 11/24/2015] [Indexed: 11/26/2022]
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28
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Jenayah AA, Saoudi S, Boudaya F, Bouriel I, Sfar E, Chelli D. Ovarian vein thrombosis. Pan Afr Med J 2015; 21:251. [PMID: 26526119 PMCID: PMC4607796 DOI: 10.11604/pamj.2015.21.251.6908] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 07/29/2015] [Indexed: 02/04/2023] Open
Abstract
Ovarian vein thrombosis (OVT) is a rare cause of abdominal pain that may mimic a surgical abdomen. It is most often diagnosed during the postpartum period. In this report, we present four cases of postoperative ovarian vein thrombosis. The complications of OVT can be significant, and the diagnosis relies on a careful examination of the radiographic findings. It can occur with lower quadrant abdominal pain, especially in the setting of recent pregnancy, abdominal surgery, pelvic inflammatory disease, or malignancy. Diagnosis can be made with confidence using ultrasound, computed tomography or magnetic resonance imaging. Treatment of ovarian vein thrombosis is particularly important in the post-partum patients, with anticoagulation therapy being the current recommendation.
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Affiliation(s)
- Amel Achour Jenayah
- Department A of Gynecology and Obstetrics, Center of Maternity and Neonatology of Tunis, Tunisia
| | - Sarra Saoudi
- Department A of Gynecology and Obstetrics, Center of Maternity and Neonatology of Tunis, Tunisia
| | - Fethia Boudaya
- Department A of Gynecology and Obstetrics, Center of Maternity and Neonatology of Tunis, Tunisia
| | - Ines Bouriel
- Department A of Gynecology and Obstetrics, Center of Maternity and Neonatology of Tunis, Tunisia
| | - Ezzeddine Sfar
- Department A of Gynecology and Obstetrics, Center of Maternity and Neonatology of Tunis, Tunisia
| | - Dalenda Chelli
- Department A of Gynecology and Obstetrics, Center of Maternity and Neonatology of Tunis, Tunisia
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29
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Labropoulos N, Malgor RD, Comito M, Gasparis AP, Pappas PJ, Tassiopoulos AK. The natural history and treatment outcomes of symptomatic ovarian vein thrombosis. J Vasc Surg Venous Lymphat Disord 2014; 3:42-7. [PMID: 26993679 DOI: 10.1016/j.jvsv.2014.07.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/15/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Information on ovarian vein thrombosis (OVT) is limited to some retrospective studies. The purpose of this prospective study was to evaluate the natural history and treatment outcomes of OVT. METHODS Patients with documented symptomatic OVT who were treated with anticoagulation and had at least 3 months of follow-up were included. Outcomes of interest were recanalization rates, pain resolution, pelvic congestion syndrome, recurrent deep venous thrombosis (DVT), and mortality. All patients underwent clinical examination and duplex ultrasound; computed tomography venography was selectively performed. RESULTS There were 23 women with a mean age of 44 years (range, 23-68 years). Fifteen (65%) right, 5 (22%) left, and 3 (23%) bilateral OVTs were detected. The median follow-up was 27 months (range, 3 months-7 years). The most common presentation was abdominal pain in nine patients (39%), followed by flank pain in six (26%). Two patients (9%) presented with dyspnea due to pulmonary embolism. The most prevalent condition was the puerperium (n = 9; 39%). Complete recanalization occurred in 16 veins (61%), partial recanalization in four veins (15%), and occlusion in six veins (24%) while patients were receiving anticoagulation. Four patients (17%) had lower extremity DVT during follow-up after the interruption of anticoagulation. Three patients (13%) developed pelvic congestion syndrome. All four deaths (17%) were due to cancer-related complications. CONCLUSIONS Symptomatic OVT is rare. Patients fare well with anticoagulation; complete recanalization occurs in about two thirds of the patients. Recurrent DVT is found in lower extremity veins after the interruption of anticoagulation in 17% of patients; mortality was seen only in cancer patients.
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Affiliation(s)
- Nicos Labropoulos
- Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY.
| | - Rafael D Malgor
- Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY
| | - Matthew Comito
- Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY
| | - Antonios P Gasparis
- Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY
| | - Peter J Pappas
- Division of Vascular Surgery, Brooklyn Hospital, New York, NY
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Postpartum ovarian vein and inferior vena cava thrombosis. Case Rep Med 2014; 2014:609187. [PMID: 25114685 PMCID: PMC4120798 DOI: 10.1155/2014/609187] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 06/07/2014] [Accepted: 06/09/2014] [Indexed: 11/18/2022] Open
Abstract
Postpartum ovarian vein thrombosis (POVT), which generally occurs 2-15 days postpartum, is a rare complication. It can be confused with acute appendicitis, pelvic infection, ovarian torsion, tubo-ovarian abscess, and pyelonephritis. It is associated with morbidity and mortality. Here, we present a patient with postpartum OVT and IVC diagnosed by US and CT findings. She was treated successfully with no further need for any interventional procedures.
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Chan WS, Rey E, Kent NE, Chan WS, Kent NE, Rey E, Corbett T, David M, Douglas MJ, Gibson PS, Magee L, Rodger M, Smith RE. Venous Thromboembolism and Antithrombotic Therapy in Pregnancy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:527-53. [DOI: 10.1016/s1701-2163(15)30569-7] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Huge Trombus including Left Renal Vein, Ovarian Vein, and Inferior Vena Cava Mimicking Renal Colic. Case Rep Urol 2014; 2014:351270. [PMID: 25140270 PMCID: PMC4129924 DOI: 10.1155/2014/351270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 07/09/2014] [Indexed: 11/30/2022] Open
Abstract
A 31-year-old female presented with acute left flank pain; she had a C/S at the postpartum day 24. Ureteral stone was suspected but ultrasound examination was normal. Then Doppler ultrasound revealed a trombus in left renal vein and inferior vena cava. Contrast enhanced MDCT scan showed swelled and nonfunctional left kidney, a trombus including distal part of left ovarian vein, left renal vein, and inferior vena cava. We started anticoagulation treatment. Further examination revealed diagnosis of chronic myeloproliferative disease. The trombus was completely recanalized at 3-month followup.
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Fiengo L, Bucci F, Patrizi G, Giannotti D, Redler A. Postpartum deep vein thrombosis and pulmonary embolism in twin pregnancy: undertaking of clinical symptoms leading to massive complications. Thromb J 2013; 11:4. [PMID: 23433174 PMCID: PMC3629711 DOI: 10.1186/1477-9560-11-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 02/03/2013] [Indexed: 11/10/2022] Open
Abstract
Background Deep Vein Thrombosis (DVT) is an important cause of morbidity and is the first cause of maternal death after delivery in Western Nations. The risk of venous thromboembolism is present throughout the pregnancy and is maximal during postpartum, especially after twin delivery. Many of the signs and symptoms of DVT overlap those of a normal pregnancy causing difficulty for diagnosis. Case report We report the case of a 33 year-old woman transferred to our Department one week after caesarean section for twin delivery. She presented with severe abdominal pain, fever, abdominal distension and shortness of breath. She had no personal or family history of thromboembolism. Computerized Tomography Scan revealed right ovarian vein thrombosis, left renal vein thrombosis extending up to the Inferior Vena Cava and pulmonary embolism with bilateral pleural effusion. Caval filter was positioned and anticoagulation therapy associated with antibiotics was instituted. Pancreatitis showed up two days after and was promptly treated. Three months after discharge the caval filter was removed and oral anticoagulation was stopped. During a 12-months follow-up, she remained stable and symptom free. Results Ovarian vein thrombosis is rare but recognition of signs and symptoms is fundamental to start adequate therapy and avoid potential serious sequelae. The risk for maternal postpartum ovarian vein thrombosis is increased by caesarean section delivery of twins. Such patients should be closely monitored. We illustrated how an underestimated condition can lead to massive complications.
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Affiliation(s)
- Leslie Fiengo
- Department of Vascular Surgery, La Sapienza University of Rome, Rome, Italy.
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Gary T, Steidl K, Belaj K, Hafner F, Froehlich H, Deutschmann H, Pilger E, Brodmann M. Unusual deep vein thrombosis sites: magnetic resonance venography in patients with negative compression ultrasound and symptomatic pulmonary embolism. Phlebology 2012. [PMID: 23202145 DOI: 10.1258/phleb.2012.012054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate the clinical characteristics of patients with pulmonary embolism (PE), negative compression ultrasound (CUS) of the lower limbs and detection of unusual deep vein thrombosis (DVT) sites by means of magnetic resonance (MR) venography. METHODS A retrospective data analysis of PE patients hospitalized at our institution from April 2009 to 2011. RESULTS From April 2009 to 2011, a total of 762 PE patients were treated at our institution. In 169 of these patients CUS for DVT was negative. In these patients MR venography was performed for further evaluation. We found venous thrombosis at unusual sites in 12 of these patients. Due to free floating thrombus masses and fear of life-threatening PE progression we inserted an inferior vena cava filter in three of these 12 patients. The leading venous thromboembolism risk factor in our patients was immobilization (5 patients, 41.7%). CONCLUSIONS We conclude that especially in patients with PE and negative CUS of the lower limbs a thrombosis of the pelvic veins should be considered in case of symptoms for venous thrombosis in this area. Further diagnostic work-up with MR venography should be scheduled in these patients especially in patients with risk factor immobilization as therapeutic consequences might occur.
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Affiliation(s)
- T Gary
- Department of Internal Medicine, Division of Angiology
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35
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Angelini M, Barillari G, Londero AP, Bertozzi S, Bernardi S, Petri R, Driul L, Marchesoni D. Puerperal ovarian vein thrombosis: two case reports. J Thromb Thrombolysis 2012; 35:286-9. [DOI: 10.1007/s11239-012-0794-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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De Stefano V, Martinelli I. Abdominal thromboses of splanchnic, renal and ovarian veins. Best Pract Res Clin Haematol 2012; 25:253-64. [PMID: 22959542 DOI: 10.1016/j.beha.2012.07.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Thromboses of abdominal veins outside the iliac-caval axis are rare but clinically relevant. Early deaths after splanchnic vein thrombosis occur in 5-30% of cases. Sequelae can be liver failure or bowel infarction after splanchnic vein thrombosis, renal insufficiency after renal vein thrombosis, ovarian infarction after ovarian vein thrombosis. Local cancer or infections are rare in Budd-Chiari syndrome, and common for other sites. Inherited thrombophilia is detected in 30-50% of patients. Myeloproliferative neoplasms are the main cause of splanchnic vein thrombosis: 20-50% of patients have an overt myeloproliferative neoplasm and/or carry the molecular marker JAK2 V617F. Renal vein thrombosis is closely related to nephrotic syndrome; finally, ovarian vein thrombosis can complicate puerperium. Heparin is used for acute treatment, sometimes in conjunction with systemic or local thrombolysis. Vitamin K-antagonists are recommended for 3-6 months, and long-term in patients with Budd-Chiari syndrome, unprovoked splanchnic vein thrombosis, or renal vein thrombosis with a permanent prothrombotic state such as nephrotic syndrome.
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Affiliation(s)
- Valerio De Stefano
- Institute of Hematology, Catholic University, Largo Gemelli, Rome, Italy.
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Hoffmann J, Amaya B, Grothoff M, Schrock C, Lampe D. Ovarian vein thrombosis as a rare cause of postpartal abdominal pain: a case report. Arch Gynecol Obstet 2012; 286:1331-2. [PMID: 22710952 DOI: 10.1007/s00404-012-2408-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Accepted: 05/31/2012] [Indexed: 11/27/2022]
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Sharma P, Abdi S. Ovarian vein thrombosis. Clin Radiol 2012; 67:893-8. [PMID: 22464919 DOI: 10.1016/j.crad.2012.01.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2011] [Revised: 01/15/2012] [Accepted: 01/25/2012] [Indexed: 11/19/2022]
Abstract
Ovarian vein thrombosis is a well-known but rare entity, which can occur during the post-partum period. This condition has also been associated with inflammatory and malignant processes within the pelvis. Untreated, complications of ovarian vein thrombosis can be significant due to the associated sepsis and risk of pulmonary embolism. Diagnosis can be made with confidence using ultrasound, computed tomography or magnetic resonance imaging. Treatment of ovarian vein thrombosis is particularly important in the post-partum patients, with anticoagulation therapy being the current recommendation.
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Affiliation(s)
- P Sharma
- Department of Radiology, Royal Hallamshire Hospital, Sheffield, UK.
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39
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Abstract
Postpartum ovarian vein thrombosis carries a significant risk of morbidity and mortality if not recognized early and managed appropriately. Background: Ovarian vein thrombosis (OVT) is a rare but potentially serious postpartum complication, which occurs in 0.05% to 0.18% of pregnancies and is diagnosed on the right side in 80% to 90% of the cases. Case Report: A 32-year-old woman presented at 15 days postpartum to our emergency department with severe abdominal pain, fever, and abdominal distension. Abdominal examination revealed right lower quadrant pain with rebound tenderness. The plain abdominal radiography evidenced a diffuse fecal stasis; abdominal ultrasound showed the presence of free fluid in the Douglas’ pouch and between small bowel loops. Diagnosis of acute appendicitis was made. The patient immediately underwent explorative laparoscopy; at surgery, a woody tumoration consistent with right ovarian vein thrombosis was found. Laparoscopic ultrasound confirmed the diagnosis. Anticoagulation therapy and antibiotics were instituted. CT-scan confirmed the presence of thrombosis up to the vena cava. The patient was discharged on postoperative day 4. At 1-month follow-up, she remained stable and symptom free. Discussion: Even though postpartum ovarian vein thrombosis is rare, recognition and treatment is needed to institute adequate therapy and avoid potential serious sequelae. The diagnosis can be established by ultrasound, CT scan, and MRI examinations, although, as in the case described, the limitation of ultrasound includes obscuration of the gonadic vein by overlying bowel gas. Conclusion: OVT should be considered in any woman in the postpartum period with lower abdominal pain, fever, and leucocytosis.
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Affiliation(s)
- Giancarlo Basili
- Health Unit 5 Pisa, Pontedera Hospital, General Surgery Unit, Via Roma 180, Pontedera, Italy, 56025.
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Virmani V, Kaza R, Sadaf A, Fasih N, Fraser-Hill M. Ultrasound, computed tomography, and magnetic resonance imaging of ovarian vein thrombosis in obstetrical and nonobstetrical patients. Can Assoc Radiol J 2010; 63:109-18. [PMID: 20870377 DOI: 10.1016/j.carj.2010.08.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 07/31/2010] [Accepted: 08/03/2010] [Indexed: 10/19/2022] Open
Abstract
Ovarian vein thrombosis is an uncommon clinical entity, most familiar to radiologists as a source of postpartum sepsis, which, if unrecognized and left untreated, has the potential for septic shock, pulmonary thromboembolism, and death. Ovarian vein thrombosis also occurs with other common inflammatory and malignant conditions in the nonobstetrical patient. This article reviews the pathophysiology, predisposing conditions, clinical findings, imaging features on ultrasonography, computed tomography, and magnetic resonance imaging of acute and chronic ovarian vein thrombosis and its appropriate clinical management.
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Affiliation(s)
- Vivek Virmani
- Department of Diagnostic Imaging, University of Ottawa, Ottawa, Ontario, Canada
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