Postpartum ovarian vein thrombosis
Day 7 of an uneventful post vaginal delivery, she developed spikes of fever and right lower abdominal pain and tenderness ? appendicitis
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Coronal and axial T2-weighted images demonstrate an enlarged and tortuous right ovarian vein showing loss of signal void. Contrast-enhanced axial and sagittal T1-weighted image reveals postcontrast enhancement of the vessel wall, edema and minimal fluid collection seen also in the right lower abdomen and around the right adnexa. There is an enlarged postpartum uterus with endometrial fluid.
Postpartum ovarian vein thrombosis is rare, however, can cause serious complications as IVC thrombosis and pulmonary thrombo-embolism. Clinical findings are nonspecific and the patient commonly present with right lower quadrant pelvic pain, fever, and leukocytosis.
The imaging modalities play an important role in these conditions, Doppler ultrasound and contrast-enhanced studies are the initial primary non-invasive modalities but MRI is more specific for diagnosis of ovarian vein thrombosis as it is more sensitive for alteration of blood flow.