Ovarian hyperstimulation syndrome (OHSS) - grade 5


Example of ovarian hyperstimulation syndrome (OHSS) 9 days after IVF.

Associated ascites, symptomatic pleural effusions and hemoconcentration, severe OHSS grade 5,  but no evidence of acute kidney failure. Hypoalbuminemia is a universal finding in OHSS.

Rapid symptom relief after right thoracentesis and subsequent general improvement.

There is no specific treatment for OHSS and as such therapy is mainly supportive. OHSS is self-limiting in its course and syndrome severeness typically parallels serum bHCG levels. However fatal outcome has been reported 1-3.

Awareness of the entity and possible findings by the radiologist is crucial, as OHSS can range from mild to potentially devastating with pulmonary edema, hydrothorax, arterial and venous embolism, tamponading pericardial effusions and myocardial ischemia inter alia. Prompt recognition and supportive therapy can prove life-saving.