Ovarian vein thrombophlebitis

Case contributed by Mohammad A. ElBeialy
Diagnosis certain


Right lower abdominal pain, fever and vomiting. Elevated inflammatory markers. Clinical suspicion of appendicitis or pelvic inflammatory disease.

Patient Data

Age: 45 years
Gender: Female

Thrombophlebitis of the mid portion of the right ovarian vein is noted with marginally enhancing dilated hypodense tubular structure of about 4.5 cm with associated mild smudging of the adjacent fat planes. Bilateral pelvic congestion with dilated enhancing pelvic veins.

The liver is homogeneous with a right liver lobe segment V 2.5 x 2.3 cm hypodense lesion with centripetal enhancement. No otherwise parenchymal distorting cystic or solid lesion identified.   There is no dilatation of the intrahepatic or extrahepatic bile duct.

The gallbladder is unremarkable without wall thickening, gallstones or pericholecystic fluid.

The spleen and pancreas are unremarkable without parenchymal abnormality. There is no dilatation of the pancreatic duct.

The adrenal glands are unremarkable without nodularity or mass lesion identified.

The kidneys demonstrate no calcified stone or parenchymal distorting cystic or solid mass lesion. There is no dilatation of the pelvi-calyceal systems or the ureter bilaterally.

Limited evaluation of the bowel loops demonstrates no significant abnormalities. No fat stranding or nodule identified.

No enlarged mesenteric or retroperitoneal lymph nodes are appreciated.

The urinary bladder is unremarkable without wall thickening or internal calcified stone.

No definite CT evidence of appendicitis or appendiceal mass lesion.

Enlarged uterus with a few small uterine fibroids with the largest posterior wall interstitial fibroid about 2 x 1.5 cm. No definite endometrial masses seen. No adnexal cystic or solid mass lesions. No pelvic masses or collection. The region of the vagina shows no abnormality.

The scanned dorso-lumbar and bony spine as well as the pelvic bones are unremarkable. Visualized lung fields are clear without masses, consolidation or airspace disease. Visualized segments of the mediastinal vessels are patent.

Case Discussion

Ovarian vein thrombophlebitis usually presents with non-specific right lower quadrant pain and fever. It is much more common on the right (~85% of cases). 

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