Ovarian vein thrombosis

Last revised by Dr Vikas Shah on 19 Jan 2022

Ovarian vein thrombosis (actually most often thrombophlebitis) occurs most commonly in postpartum patients and can result in pulmonary emboli. A presentation is usually with acute pelvic pain in the postpartum period, then termed puerperal ovarian vein thrombosis or postpartum ovarian vein thrombosis.

The estimated incidence of postpartum ovarian vein thrombosis is ~1:600-1:2000 deliveries 16.

  • pregnancy - most common risk factor 17
  • oral contraceptives
  • pelvic infection
  • malignancy
  • recent surgery
  • idiopathic up to 6℅

The dominant symptom of clinically significant ovarian vein thrombosis is a pain in the lower abdomen / right lower quadrant pain and fever, which usually appears approximately ten days postpartum with no response to antibiotic treatment. There may occasionally be a palpable mass felt in the right iliac fossa.

  • in ~80-90% of cases, the right ovarian vein is involved, possibly due to retrograde flow in the left vein preventing stasis and ascending infection
  • ~14% of cases can have bilateral involvement
  • ~6% of cases involve the left ovarian vein only

May be difficult if there is overlying bowel gas and the ovarian vein may not be identified in every case 14.

  • tubular/serpiginous hypoechoic structure in the adnexa adjacent to the ovarian artery
  • if the ovarian vein is identifiable, the absence of Doppler flow can be a diagnostic feature
  • tubular structure with an enhancing wall and low-attenuation thrombus in the expected location of the ovarian vein

A filling defect in the ovarian vein will be observed as a loss of the normal flow void on T2 weighted images, with asymmetric enlargement and edema of the ipsilateral ovary.

Appropriate treatment consists of a combination of anticoagulation and antibiotics. However, mortality rates of up to 5% have been observed, making the diagnosis an important one to consider in the postpartum patient.

Considerations include:

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Cases and figures

  • Case 1
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  • Case 2: involving left ovarian vein (concurrent diveritculitis)
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  • Case 3
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  • Case 4
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  • Case 5
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  • Case 6
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  • Case 7
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  • Case 8
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  • Case 9: recanalized
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  • Case 10
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  • Case 11
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