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Dibas YMS, Qasarwa M. Unique partial duplication of the left ovarian vein: A case report. Radiol Case Rep 2024; 19:5485-5487. [PMID: 39285973 PMCID: PMC11403896 DOI: 10.1016/j.radcr.2024.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 08/05/2024] [Accepted: 08/07/2024] [Indexed: 09/19/2024] Open
Abstract
Partial duplication of the left ovarian vein is an extremely rare anatomical variation with significant clinical implications. We report the case of a 52-year-old female with no significant medical history, presenting with a 2-month history of vague upper abdominal pain. A diagnostic abdominal CT scan revealed an incidental finding of partial duplication of the left ovarian vein. The vein was enlarged, measuring 8 mm in diameter, and displayed a unique bifurcation at the lower end of the L4 vertebra, reuniting at the upper endplate of the L3 vertebra. Additionally, a short 4 mm segment connected the duplicated mid-segments. This case underscores the importance of thorough imaging and evaluation in identifying rare vascular anomalies, which can have significant implications for diagnosis and management.
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Affiliation(s)
- Yazan M S Dibas
- Department of Radiology, Al-Makassed Islamic Charitable Hospital, East Jerusalem, Palestine
| | - Mohammed Qasarwa
- Department of Emergency, Jenin Government Hospital, Jenin, Palestine
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Cheung W, Stegwee S, van Hamont D, Visser J. Postpartum ovarian vein thrombosis with left renal venous infarction after vaginal delivery. BMJ Case Rep 2024; 17:e258877. [PMID: 38442978 PMCID: PMC10916174 DOI: 10.1136/bcr-2023-258877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
A primipara in her late 20s presented with abdominal pain and pain in the left flank 14 days after a ventouse delivery. She was treated with antibiotics, antiemetics and analgesics with the initial differential diagnosis of cystitis, pyelonephritis or nephrolithiasis. Despite the treatment, the patient experienced increased colic pain and nausea. An ultrasound showed an enlarged left kidney, suggesting pyelonephritis, and thereby, the antibiotic treatment was adjusted accordingly. Despite additional pain medication, pain relief could not be achieved. The diagnosis of ovarian venous thrombosis was considered, and an abdominal CT scan confirmed the diagnosis. The patient was treated with anticoagulant therapy. Hypercoagulability work-up revealed a heterozygous mutation of the Factor V Leiden. Our patient awaits a haematologic follow-up.
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Affiliation(s)
- Wingman Cheung
- Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, The Netherlands
| | - Sanne Stegwee
- Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, The Netherlands
- Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Dennis van Hamont
- Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, The Netherlands
| | - Jantien Visser
- Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, The Netherlands
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Hirata Y, Kawamura H, Kato M, Ezaka Y, Yoshida Y. Rectus Sheath Hematoma Triggered by Post-cesarean Anticoagulant Therapy for Intraoperative Acute Pulmonary Thromboembolism: A Case Report. Cureus 2023; 15:e49034. [PMID: 38116345 PMCID: PMC10728606 DOI: 10.7759/cureus.49034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/21/2023] Open
Abstract
Anticoagulant therapy is essential for the prevention or treatment of peripartum venous thromboembolism (VTE). Administration of a therapeutic dose of anticoagulant immediately after cesarean section may result in the formation of a rectus sheath hematoma. A 32-year-old Japanese woman delivered twin neonates by cesarean section at 37+5 weeks of gestation. After the removal of the placenta, the patient suddenly complained of left anterior chest pain and dyspnea with hypotension and desaturation, requiring the administration of oxygen and vasopressors. Postoperative contrast-enhanced computed tomography (CT) revealed pulmonary embolism and massive right ovarian vein thrombosis (OVT). An inferior vena cava filter was placed and continuous intravenous heparin was started. A rectus sheath hematoma was noted on postoperative day 2 (POD 2). On POD 5, heparin administration was temporarily discontinued because of an enlarged rectus sheath hematoma. Approximately 24 hours later, the hemoglobin level recovered, and heparin administration was resumed. No further expansion of the hematoma was observed. When a rectus sheath hematoma is formed due to treatment with a therapeutic dose of anticoagulant immediately after cesarean section for peripartum VTE, temporary suspension of anticoagulant administration is reasonable to prevent further expansion of the hematoma without fatal complication.
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Affiliation(s)
- Yuki Hirata
- Obstetrics and Gynecology, University of Fukui, Fukui, JPN
| | | | - Masataka Kato
- Obstetrics and Gynecology, University of Fukui, Fukui, JPN
| | - Yukie Ezaka
- Obstetrics and Gynecology, University of Fukui, Fukui, JPN
| | - Yoshio Yoshida
- Obstetrics and Gynecology, University of Fukui, Fukui, JPN
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Wang JJ, Hui CC, Ji YD, Xu W. Computed tomography diagnosed left ovarian venous thrombophlebitis after vaginal delivery: A case report. World J Clin Cases 2023; 11:896-902. [PMID: 36818636 PMCID: PMC9928707 DOI: 10.12998/wjcc.v11.i4.896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/21/2022] [Accepted: 01/12/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Postpartum ovarian vein thrombophlebitis (POVT) is a rare but serious postpartum complication that affects mostly postpartum women. A high index of suspicion is required when faced with sudden postpartum abdominal pain.
CASE SUMMARY A 25-year-old healthy woman who accepted a vaginal delivery procedure suffered fever (temperature 39.6℃) one day after delivery, accompanied with left lower abdominal pain. Physical examination indicated mild tenderness in the left lower abdomen, accompanied with rebound pain. The patient was confirmed to have left ovarian venous thrombosis with inflammation after receiving a multi-detector row computed tomography scan.
CONCLUSION POVT is a rare and dangerous postpartum complication. A high index of suspicion is required for the occurrence of ovarian venous thrombosis when faced with postpartum abdominal pain and fever. Early application of Doppler ultrasound, computed tomography, magnetic resonance imaging and other auxiliary examinations is conducive to timely and accurate diagnosis of POVT, thus reducing maternal mortality.
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Affiliation(s)
- Jin-Jin Wang
- Department of Radiology, The Ninth People’s Hospital of Suzhou City, Suzhou 215200, Jiangsu Province, China
| | - Chu-Chu Hui
- Department of Ultrasound, The Ninth People’s Hospital of Suzhou City, Suzhou 215200, Jiangsu Province, China
| | - Yi-Ding Ji
- Department of Radiology, The Ninth People’s Hospital of Suzhou City, Suzhou 215200, Jiangsu Province, China
| | - Wei Xu
- Department of Emergency Medicine, The Ninth People’s Hospital of Suzhou City, Suzhou 215200, Jiangsu Province, China
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Muo EC, Iwanaga J, Olewnik Ł, Dumont AS, Tubbs RS. Duplication of the ovarian vein: comprehensive review and case illustration. Anat Cell Biol 2022; 55:251-254. [PMID: 35410982 PMCID: PMC9256477 DOI: 10.5115/acb.21.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/17/2022] [Accepted: 03/03/2022] [Indexed: 11/27/2022] Open
Abstract
Variations of the ovarian veins can impact imaging diagnosis, surgical procedures of the region, and can be related to clinical findings such as compression of the ureter. Therefore, a good working knowledge of such variants is important to the clinician who interprets imaging of the posterior abdominopelvic region of women and surgeons who operate in this region. Herein, we present a comprehensive review of duplicated ovarian veins and provide a case illustration.
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Affiliation(s)
- Edward C Muo
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada.,Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA.,University of Queensland, Brisbane, Australia
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Zabihi Mahmoudabadi H, Najjari K, Oklah E, Kor F. Ovarian vein and IVC thrombosis due to normal vaginal delivery; a case report and literature review. Int J Surg Case Rep 2021; 83:105975. [PMID: 34004567 PMCID: PMC8141766 DOI: 10.1016/j.ijscr.2021.105975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/02/2021] [Accepted: 05/08/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Ovarian vein thrombosis (OVT) is exceedingly rare, which commonly occurs in postpartum patients and can result in serious complication such as pulmonary emboli. With a presentation often mimicking that of acute abdomen, it can be often misdiagnosed and mistreated. CASE PRESENTATION A 30-year-old woman referred with right lower quadrant abdominal pain, nausea and anorexia, one week after normal vaginal delivery. Physical examination demonstrated tenderness and rebound tenderness at the right side of the abdomen, with a stable vital sign except 38 °C fever. She had no history of coagulation problems or thrombotic disorders. Patient was admitted on a suspicion of appendicitis and was prescribed antibiotics followed by pelvic and abdominal ultrasonography that indicated an 8 to 10-centimeter hypoechoic tubular structure on the right side, next to the IVC. CT scan with contrast showed clear dilatation and thrombosis of the right ovarian vein with spread to the IVC. Anticoagulant treatment was started with 1000 intravenous units of heparin per hour, along with aPTT control, with a disappearance of the symptoms after 72 h. CONCLUSION Suspicion of OVT should be high in cases where patients refer with abdominal pain after childbirth, this diagnosis should be taken into account. In the absence of proper and timely diagnosis, it may lead to serious complications or mortality of the mother. CT scan with contrast and at least 3- months anticoagulant therapy (in case of thrombosis spreading to the IVC, this period should be extended) is recommended in diagnosing and treatment of OVT.
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Affiliation(s)
- Hossein Zabihi Mahmoudabadi
- Sina Hospital, Department of Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Khosrow Najjari
- Sina Hospital, Department of Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Edmund Oklah
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Kor
- Department of Surgery, Golestan University of Medical Sciences, Iran.
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Alsharif S, Subahi A, Shirah B, Alshamrani KM, Alhazmi TA, Mesurolle B. Incidental Gonadal Vein Thrombosis Diagnosed Using Computed Tomography Imaging: A Single-Center, Retrospective, Cohort Study. Cureus 2021; 13:e15741. [PMID: 34285850 PMCID: PMC8286637 DOI: 10.7759/cureus.15741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives Gonadal vein thrombosis is an uncommon but serious condition that can be fatal if it goes unnoticed. Up to 80% of cases occur in patients after delivery, hysterectomy, or lymphadenectomy for gynecological neoplasms. The objective of this study was to determine the incidence of gonadal vein thrombosis using computed tomography (CT) imaging at our center and to describe associated risk factors. Methods A retrospective, single-center, observational study was conducted at King Abdulaziz Medical City in Jeddah, Saudi Arabia. Data were collected for all patients diagnosed with incidental gonadal-vein-thrombosis using contrast-enhanced computed tomography imaging of the abdomen and pelvis between January 2005 and December 2017. We included all patients with incidental findings of gonadal vein thrombosis and excluded those with incomplete data. Results In total, 58/68,268 (0.08%) patients were included. Fifty-seven patients were females, and only one was male. The mean age (years) of the patients was 50.0±15.0 (range 4-87). Thirty-four patients (59%) had right gonadal vein thrombosis, 20 (34%) had thrombosis on the left side, and four (7%) had bilateral thrombosis. Nineteen patients (33%) had undergone pelvic surgery previously. Forty-four patients (76%) had a malignancy at the time of diagnosis. Forty-two patients (72%) were treated with anticoagulants after the diagnosis. Conclusion Gonadal vein thrombosis is a rare clinical entity with vague clinical presentation. The incidence in the oncology population is similar to the reported incidence in the obstetric population. Initiation of anticoagulation therapy is important to treat this condition and limit complications.
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Affiliation(s)
- Shaza Alsharif
- Medical Imaging, King Abdullah International Medical Research Center, Jeddah, SAU
- Medical Imaging, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Medical Imaging, Ministry of the National Guard - Health Affairs, Jeddah, SAU
| | - Ahmed Subahi
- College of Science and Health Professions, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Bader Shirah
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Khalid M Alshamrani
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
- Medical Imaging, Ministry of the National Guard - Health Affairs, Jeddah, SAU
- College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Turki A Alhazmi
- Medical Imaging, Ministry of the National Guard - Health Affairs, Jeddah, SAU
- Research Office, King Abdullah International Medical Research Center, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- College of Medicine, Umm Alqura University, Makkah, SAU
| | - Benoit Mesurolle
- Department of Radiology, Pôle Santé République, Clermont-Ferrand, FRA
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