Ovarian vein thrombosis

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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 post-partumpostpartum period, then termed puerperal ovarian vein thrombosis (POVT) or post-partumpostpartum ovarian vein thrombosis (PPOVT).

Epidemiology

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

Clinical presentation

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

Pathology

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

Radiographic features

CT

The characteristic CT findings consist of a 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. If the ovarian vein is identifiable then, the absence of Doppler flow can be a diagnostic feature.

Complications

Treatment and prognosis

Appropriate treatment consists of a combination of anticoagulation and antibiotics.

Differential diagnosis

Considerations include:

  • -<p><strong>Ovarian vein thrombosis (OVT)</strong> (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 post-partum period, then termed <strong>puerperal ovarian vein thrombosis (POVT)</strong> or <strong>post-partum ovarian vein thrombosis (PPOVT)</strong>.</p><h4>Epidemiology</h4><p>The estimated incidence of postpartum ovarian vein thrombosis (PPOVT) is ~1:600-1:2000 deliveries <sup>16</sup>.</p><h4>Clinical presentation</h4><p>The dominant symptom of clinically significant ovarian vein thrombosis is pain in the lower abdomen and pyrexia which usually appears approximately ten days post-partum with no response to antibiotic treatment.  There may occasionally be a palpable mass felt in the right iliac fossa.</p><h4>Pathology</h4><h5>Location: laterality</h5><ul>
  • +<p><strong>Ovarian vein thrombosis (OVT)</strong> (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 <strong>puerperal ovarian vein thrombosis (POVT)</strong> or <strong>postpartum ovarian vein thrombosis (PPOVT)</strong>.</p><h4>Epidemiology</h4><p>The estimated incidence of postpartum ovarian vein thrombosis (PPOVT) is ~1:600-1:2000 deliveries <sup>16</sup>.</p><h4>Clinical presentation</h4><p>The dominant symptom of clinically significant ovarian vein thrombosis is pain in the lower abdomen and pyrexia 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.</p><h4>Pathology</h4><h5>Location: laterality</h5><ul>
  • -</ul><h4>Radiographic features</h4><h5>CT</h5><p>The characteristic CT findings consist of a tubular structure with an enhancing wall and low-attenuation thrombus in the expected location of the ovarian vein.</p><h5>Pelvic ultrasound</h5><p>May be difficult if there is overlying bowel gas and the ovarian vein may not be identified in every case <sup>14</sup>. If the ovarian is identifiable then absence of Doppler flow can be a diagnostic feature.</p><h4>Complications</h4><ul><li>distal emboli: <a href="/articles/pulmonary-embolism">pulmonary emboli</a> <sup>15</sup>
  • +</ul><h4>Radiographic features</h4><h5>CT</h5><p>The characteristic CT findings consist of a tubular structure with an enhancing wall and low-attenuation thrombus in the expected location of the ovarian vein.</p><h5>Pelvic ultrasound</h5><p>May be difficult if there is overlying bowel gas and the ovarian vein may not be identified in every case <sup>14</sup>. If the ovarian vein is identifiable, the absence of Doppler flow can be a diagnostic feature.</p><h4>Complications</h4><ul><li>
  • +<a href="/articles/pulmonary-embolism">pulmonary emboli</a> <sup>15</sup>

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