Presentation
History of recent hysterectomy due to placenta accreta.
Patient Data
The ovarian veins bilaterally are totally thrombosed along their courses with massive thrombosis of their pelvic tributaries forming pelvic mass-like structures. On the left side, the thrombosis extends to the left renal vein but not into the IVC.
Pelvic fat stranding with minimal free fluid.
Bilateral hydronephrosis and hydroureter.
Persistent nephogram of the left kidney on delayed phase.
Case Discussion
Bilateral involvement occurs in 6% of cases of ovarian vein thrombosis. Pregnancy and recent surgery are considered risk factors. In this case, there is also extensive thrombosis of the pelvic tributaries of the ovarian veins resulting in mass-like structures which probably account for bilateral backpressure on ureters and kidneys. The persistent nephogram on the left side could be due to either obstructive uropathy or left renal vein thrombosis; however, the latter possibility is more likely as it is unilateral.
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