Presentation
Shock, chest and abdominal. 4 days post egg retrieval. Patient thrombolysed in the emergency department
Patient Data
Innumerable cystic structures in enlarged ovaries. A moderate amount of pelvic free fluid is seen.
No ovarian torsion. Normal uterus. Normal thickness endometrium.
There are multiple filling defects within segmental pulmonary arteries within the right and left lung - no cardiac thrombus.
Bilateral small volume pleural effusions with no lung parenchymal changes.
Segmental filling defects within the right lower lobe pulmonary arteries are seen. Bilateral pleural effusions are slightly increased in size. No further thrombus is seen. Confirms the findings of ascites with enlarged ovaries,
Collapsed IVC is in keeping with hypovolemic shock.
Contrast retention within the gallbladder may indicate poor renal function.
Case Discussion
A constellation of symptoms and history is concerning for grade 5 ovarian hyperstimulation syndrome with pulmonary embolism and pleural effusions on CTPA.
These are rare (0.5%) complications of ovarian stimulation and, in this case, present as a life-threatening hypovolemic shock.