Computed tomographic features of puerperal ovarian vein thrombosis

[Postpartum ovarian vein thrombophlebitis: report of 5 cases and review of the literature]

OBJECTIVE

Postpartum ovarian vein thrombophlebitis (POVT) is an uncommon life-threatening situation. It should be systematically evoked in case of persistent fever during the postpartum. We describe here the imaging techniques to assert the diagnosis and the different therapeutic options.

METHODS AND MATERIAL

We report five cases from 1997 to 2002. Only one patient was surgically treated.

RESULTS

No death was observed. In all cases, fever and pain rapidly disappeared.

CONCLUSION

Search for postpartum ovarian vein thrombophlebitis should be undertaken in patients with persistent fever. Treatment is more often medical.

Sonography of postpartum ovarian vein thrombophlebitis

PURPOSE

We report the gray-scale, color, and power Doppler findings in 3 cases of postpartum ovarian vein thrombophlebitis (PPOVT), an uncommon but potentially lethal disorder.

METHODS

A retrospective review of medical records revealed 3 patients with PPOVT who had pelvic sonography performed during the disease course.

RESULTS

The sonographic findings of PPOVT included a tubular, hypoechoic mass identified anterior to the psoas muscle in all cases. Perivenous phlegmon formation resulted in hydronephrosis and obstructive periureteritis in 1 case. Inferior vena cava involvement was detected in 2 cases. Decreases in the sizes of the thrombus and the phlegmon were seen on post-treatment studies.

CONCLUSIONS

The long course of the thrombosed ovarian vein and the presence of inferior vena cava thrombus are sonographic signs helpful in distinguishing PPOVT from other inflammatory conditions. Sonography cannot be proposed as a primary tool in the diagnosis of PPOVT because it successfully diagnosed only 1 of our 3 cases. However, sonography may be useful in monitoring the response to anticoagulant therapy.

Postpartum ovarian veins thrombophlebitis

Puerperal ovarian vein thrombophlebitis (POVT) is a rare postpartal complication. Its incidence is about 0.05%. POVT can follow a term pregnancy, a premature delivery, an abortion or an ectopic pregnancy. POVT usually presents as a syndrome consisting in lower abdominal pain and fever which does not respond to adequate antibiotics. We present a case report, in which the diagnosis was based upon computed tomography.

Ovarian vein thrombosis

We report five cases of OVT and review the literature on this disease. Among our patients OVT was not suspected clinically and was diagnosed by CT scanning or MRI. Ultrasound imaging, utilized in three cases, failed to detect OVT. Although this disease usually occurs after delivery, in two cases it was diagnosed before delivery. Of the two postpartum cases, one had a typical presentation and the other was asymptomatic. The final case was diagnosed incidentally 5 months after removal of an ovarian carcinoma. Our experience suggests that this disease may be underdiagnosed. More widespread use of CT scanning and MRI may lead to more frequent diagnosis of OVT. The role that clinically silent OVT may play in peripartum pulmonary embolism should be clarified.

Postpartum ovarian vein thrombosis presenting as ureteral obstruction: a case report and review of the literature

Postpartum ovarian vein thrombosis, well described in the obstetrical literature with an incidence approaching 1 in 2,000 pregnancies, can present as a life-threatening complication. Although infrequent, thrombophlebitis of the ovarian vein may remain unrecognized and result in pulmonary embolism with dire outcome. Postpartum ovarian vein thrombosis can present initially as an acute ureteral obstruction, making it incumbent upon the urologist to recognize the entity with its associated radiological and clinical findings. A case report is presented to illustrate the disorder.