Ovarian vein thrombosis

Dr Zishan Sheikh and Radswiki et al.

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

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

The dominant symptom of clinically significant ovarian vein thrombosis is 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.

Location: laterality
  • 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% cases can have bilateral involvement
  • ~6% of cases involves the left ovarian vein only
CT
  • tubular structure with an enhancing wall and low-attenuation thrombus in the expected location of the ovarian vein
Pelvic ultrasound

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

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

Complications

Considerations include:

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Article Information

rID: 12758
Synonyms or Alternate Spellings:
  • Thrombophlebitis of the ovarian vein
  • Ovarian vein thrombophlebitis
  • Ovarian venous thrombosis
  • Thrombosis of the ovarian vein
  • Ovarian vein thrombosis (OVT)
  • Puerperal ovarian vein thrombosis
  • POVT
  • Postpartum ovarian vein thrombosis
  • PPOVT

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Cases and Figures

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    Case 1
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    Case 2: involving left ovarian vein (concurrent diveritculitis)
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    Case 3
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