Ovarian Vein Thrombosis Research Articles

MRI appearance of the pelvis in the post cesarean-section patient

Fever in the post-cesarean section patient may indicate the presence of a potentially life-threatening complication, including abscess, ovarian vein thrombosis, and uterine dehiscence. Imaging findings are often utilized to ascertain the presence or absence of such complications. Familiarity with the normal findings in the post-operative period is essential in making this determination. The purpose of this investigation is to describe the MRI appearance of the post-cesarean section pelvis. Over a 67-month period, 50 patients with persistent low-grade fevers following c-section were referred for MR imaging. Imaging was performed 3–10 days post-operatively. Axial T 1-weighted and T 2-weighted images were acquired in addition to sagittal T 2-weighted images. Coronal images were obtained in some cases. Clinical correlation was obtained through the patients charts, confirming discharge of the patients in stable condition. The uterine incision site usually demonstrated findings consistent with subacute hematoma. The anterior uterine myometrium demonstrated enlargement relative to the posterior uterine wall. Bladder flap hematomas were seen in 64% of cases. Three cases (6%) demonstrated parametrial edema and none of these patients demonstrated ovarian vein thrombosis. Two cases of pelvic hematoma were noted. The normal post-c-section incision site may demonstrate increased or decreased signal intensity on T 2-weighted images and intact endometrial and serosal layers mitigate against the diagnosis of incisional dehiscence. Bladder flap hematomas occurred in slightly more than half the cases. Parametrial edema and pelvic hematoma can be seen as post-surgical changes.

Ovarian vein thrombosis: a common incidental finding in patients who have undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy with retroperitoneal lymph node dissection.

Our objective was to use CT to determine the frequency of ovarian vein thrombosis in patients who have undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy with retroperitoneal lymph node dissection. With contrast-enhanced conventional CT of the abdomen and pelvis, we ruled out recurrent malignant disease in 50 patients who in the previous 3-20 months had undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy with retroperitoneal lymph node dissection. Thirty of these patients had ovarian cancer (60%), 15 (30%) had cervical cancer, and five (10%) had endometrial cancer. In 40 (80%) of the 50 patients, contrast-enhanced CT revealed ovarian vein thrombosis. No surrounding stranding to suggest phlebitis was seen in any of the patients. None of the patients reported symptoms that would suggest pulmonary embolism. Ovarian vein thrombosis is a common incidental finding in patients who have undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy with retroperitoneal lymph node dissection. No treatment is necessary in cases uncomplicated by thrombophlebitis or pulmonary embolism.

Risk Factors Associated with Postpartum Ovarian Vein Thrombosis

Thrombosis of the ovarian vein is a remarkable process occuring within a few days of labor in 1:500-1:2000 women. Its presentation is characterized by fever, abdominal pain and occasionally by a palpable abdominal mass that in earlier years sometimes lead to explorative laparotomy. With the advent of modern imaging techniques the diagnosis can be made relatively easily. The pathogenesis has been attributed to an infectious process expanding from the uterus to the right ovarian vein and stasis. A predisposition towards thrombosis has not been so far explored. In this study we retrospectively analysed the clinical features, diagnosis and treatment of 22 patients with objective documentation of post partum ovarian vein thrombosis (POVT) and assessed potential risk factors. In 11 of the 22 patients (50%) inherited prothrombotic risk factors were detected as follows: 4 were heterozygous for factor V G1691A, 2 had protein S deficiency, one had protein S deficiency and was heterozygous for factor V G1691A, and 4 were homozygous for MTHFR C677T. Eight of the 11 patients who bore a prothrombotic predisposition underwent cesarean section. Taken together, the data suggest that POVT may result from the combined effect of an infection, cesarean section and a prothrombotic tendency.

Role of duplex color Doppler ultrasound, computed tomography, and MR angiography in the diagnosis of septic puerperal ovarian vein thrombosis

Septic puerperal ovarian vein thrombosis (SPOVT) is one of the underlying etiologies of puerperal fever. A correct diagnosis of this condition is important because adequate treatment requires additional administration of anticoagulants. The purpose of this study was to evaluate the role of duplex color Doppler ultrasound (CDUS), computed tomography (CT), and magnetic resonance angiography (MRA) in the detection of SPOVT. Twenty-six patients with puerperal fever suspected to be due to SPOVT and unresponsive to broad antibiotic treatment for at least 48 h were included in a prospective study using CDUS, CT, and MR imaging including MRA. Examinations were analyzed and then correlated to a standard of reference gathered from surgical and clinical follow-up data and from results of imaging. SPOVT was present in nine patients (right side n = 8, bilateral n = 1). CDUS was inconclusive due to gaseous distention of the bowel or obesity in 13 of 26 cases. After counting inconclusive findings as wrong results for statistical purposes, sensitivity, specificity, and accuracy for CDUS were 55.6%, 41.2%, and 46.2%, respectively. CT had a sensitivity of 77.8% with a specificity of 62.5%; accuracy was 68.0%. MRA rendered conclusive results in all evaluated patients, resulting in a sensitivity and specificity of 100%. MRA is recommended in all patients with inconclusive CDUS findings and persistent suspicion for SPOVT. CT has the advantage of more rapid access and lower cost and thus will probably remain a sufficiently accurate alternative. Septic puerperal ovarian vein thrombosis (SPOVT)-Computed tomography-Magnetic resonance angiography-Ultrasound.

Postpartum ovarian vein thrombosis with massive inferior vena cava thrombus formation

Postpartum ovarian vein thrombosis with massive inferior vena cava thrombus formation

Imaging of Puerperal Septic Thrombophlebitis

Our objective was to compare prospectively the abilities of MR imaging, CT, and sonography to reveal puerperal septic thrombophlebitis in the pelvis.Seventy-six women with puerperal fever for 5 days refractory to antimicrobial therapy underwent MR imaging, CT, and sonography. We obtained unenhanced axial CT images followed by enhanced images after the administration of an oral contrast agent for which we followed a specific protocol. Axial T1- and T2-weighted spin-echo MR images with phase reconstruction and sagittal T1-weighted MR images were obtained. Real-time sonography was performed using Doppler color flow mapping and spectral waveform analysis.Of the 76 women, 64 completed studies with all three techniques. Ovarian vein thrombosis was diagnosed in 12 women. True-positive results were indicated when at least two of the three studies showed the presence of a clot; true-negative results were indicated when at least two of the three studies showed a lack of thrombosis. MR imaging and CT revealed both o...

Antepartum Bilateral Ovarian Vein Thrombosis: Magnetic Resonance Imaging Diagnosis

Antepartum cases of ovarian vein thrombosis are extremely rare and often misdiagnosed. A 22-year-old nullipara at 29 weeks' gestation presented with right lower quadrant pain and fever. Sonography revealed a tubular, hypoechoic mass. At laparotomy, a noninflamed appendix was found and a 2 x 4 cm retroperitoneal mass was palpated near the right ureter. Postoperative magnetic resonance imaging (MRI) revealed bilateral thrombosis of the ovarian veins with caval extension. Therapeutic anticoagulation was achieved, but the patient underwent cesarean delivery 4 days later due to active labor and malpresentation. Postoperative MRI showed no extension of the thrombi, and her postpartum course was otherwise unremarkable. MRI is a valuable, noninvasive tool in the diagnosis of venous thrombi in pregnancy.

Postpartum ultrasonographic diagnosis of inferior vena cava thrombus associated with ovarian vein thrombosis

Postoperative ultrasonographic assessment as a result of unremitting fever after cesarean section depicted a large pedunculated thrombus within the inferior vena cava at the level of the right renal vein. Subsequent imaging studies revealed that this thrombus was the distal extension of right ovarian vein thrombosis into the inferior vena cava. (Am J Obstet Gynecol 1997;177:474-5.)

Diagnosis of post-partum ovarian vein thrombophlebitis by color Doppler ultrasonography: about 10 cases.

Post-partum ovarian vein thrombosis is often overlooked or mistaken for other complications such as endometritis. Color Doppler ultrasonography is a very good diagnostic method when properly indicated and correctly interpreted according to clinical data. This study reports ten cases that were retrospectively studied, during which color Doppler ultrasonography was used. The clinical signs and the results are reviewed. The lesions were clearly visualized in eight of the ten cases; one of the two failures resulted from a methodological fault (uninterpretable result); the other one was due to the lack of experience of the operator and nonrecognition of the clinical signs. Thrombosis appears as a hypoechogenic and tubular image. This type of examination is particularly indicated in the presence of certain clinical signs that were observed in our cases: fever and iliac pain are the main precursor signs, often associated with abdominal meteorism and slow digestive transit; provoked cul-de-sac pain during vaginal probing was the only constant sign, sometimes associated with painful swelling.

Ovarian vein thrombosis with symptoms prior to term — a case report

A case with ovarian vein thrombosis before delivery is presented. C-reactive protein exceeded 200 mg/l, and the patient was treated for a suspected infection before the true diagnosis was revealed by CT. After aggressive anti-coagulant therapy, a follow-up CT showed complete remission.

Absence of flow in ovarian vein by time-of-flight magnetic resonance angiography without evidence of thrombosis

A case of absent flow in the left ovarian vein was diagnosed on time-of-flight (TOF) magnetic resonance angiography (MRA) while investigating for pelvic vein thrombosis in a 53-year-old female. This appearance should not be misdiagnosed as a sign of ovarian vein occlusion or thrombosis. Magnetic resonance imaging (MRI) is a sensitive noninvasive imaging modality in such a clinical setting. Familiarity with the potential pitfalls of different MRA techniques is essential for correct diagnosis. A review of different MRA techniques in evaluation of pelvic venous thrombosis is presented.

Zweizeitige Geburt bei extremer Frühgeburtlichkeit des ersten Mehrlings: Bericht von 3 Fällen

Fragestellung: Die extreme Frühgeburtlichkeit in einem Schwangerschaftsalter zwischen 23 und 26 Wochen ist mit einer hohen perinatalen Mortalität und Morbidität verbunden. Ein aktives, schwangerschaftsprolongierendes Vorgehen nach der unaufhaltsamen Geburt des ersten Feten bei einer Mehrlingsschwangerschaft könnte in diesem Schwangerschaftsalter wertvolle Zeit für die in utero verbliebenen Feten gewinnen. Patientinnen und Methodik: Bei drei Mehrlingsschwangerschaften (einmal Zwillinge, zweimal Drillinge) kam es in der 23 + 2, 24 + 2 und 24 + 7 Schwangerschaftswoche zur Spontangeburt des ersten Mehrlings. Nach der Geburt dieses Kindes wurde die Nabelschnur ligiert, eine Cerclage in der Technik nach McDonald angelegt sowie eine peri- und postoperative Tokolyse und Antibiose verabreicht. Ergebnisse: Bei zwei Schwangerschaften (einmal Drillinge, einmal Zwillinge) gelang eine Verlängerung der Schwangerschaft um 22 bzw. 70 Tage. Vier der fünf Kinder überlebten. Der Wochenbettverlauf dieser Mütter war unauffällig. Bei der dritten Schwangerschaft (Drillinge) kam es am Tag der Geburt des ersten Kindes zu einer Amnioninfektion. Das erste, spontan geborene Kind überlebte; die am Tag danach durch Sektio entbundenen Kinder verstarben. Die Mutter erlitt im Wochenbett eine Sepsis aufgrund einer infizierten Ovarialvenenthrombose. Schlußfolgerung: Die Prolongation einer Mehrlingsschwangerschaft nach der Geburt des ersten Kindes in einem Schwangerschaftsalter von 23 bis 26 Wochen ist in gewissen Fällen eine erfolgversprechende Maßnahme, um die Reife der intrauterin verbliebenen Feten zu erhöhen. Dieser Vorteil muß gegen die negativen Auswirkungen einer möglicherweise auftretenden Amnioninfektion abgewogen werden.

Imaging of pelvic postpartum complications.

Differentiation between endometritis and RPOC in febrile postpartum patients is commonly requested by clinicians. Sonography is the screening technique of choice to assess the endometrial contents. For cases in which the retained placenta is calcified or still has demonstrable blood flow, a specific diagnosis of RPOC can be made. In more complicated cases, a CT scan or an MR image may be requested. In addition to evaluating the uterus and any intra- or extrauterine fluid collections, attention must be paid to the ovarian veins to exclude the diagnosis of ovarian vein thrombosis.

Puerperal ovarian vein thrombosis in a triplet pregnancy complicated by a single intrauterine death

(1997). Puerperal ovarian vein thrombosis in a triplet pregnancy complicated by a single intrauterine death. Journal of Obstetrics and Gynaecology: Vol. 17, No. 6, pp. 585-585.

Septic pelvic thrombophlebitis or refractory postpartum fever of undetermined etiology.

The objective of this study was to review and characterize the presentation, diagnostic dilemmas, management, and prognosis of postpartum septic pelvic thrombophlebitis. Medical records of postpartum women with the diagnosis of septic pelvic thrombophlebitis were reviewed for the 8-year period 1986-1994. Cases of documented ovarian vein thrombosis or those with other pelvic pathology on imaging study were excluded. Thirty-one women, four following vaginal delivery and 27 following cesarean delivery, with a final diagnosis of septic pelvic thrombophlebitis were identified. All patients demonstrated refractory febrile morbidity (mean 5.5 +/- 1.9 days prior to instituting heparin therapy) despite multiagent antimicrobial therapy with ampicillin, gentamicin, and clindamycin. Imaging studies (CT and/or ultrasound) were performed in 20 women and revealed no pelvic pathology. The patients required an average of 4.7 +/- 2.1 days (median 5, range 1-9 days) of heparin therapy before defervescence. Heparin levels were therapeutic at a mean of less than 24 h (range 6-24 h). The average dose of heparin required was 16.0 +/- 3.0 U/kg/h. Nine women had 13 subsequent pregnancies without recurrent thromboembolic complications. Currently available imaging studies cannot diagnose the entity we now define as septic pelvic thrombophlebitis (once cases of ovarian vein thrombosis are excluded). Our findings do not support the time-honored rule that septic pelvic thrombophlebitis responds within 24-48 h to therapeutic anticoagulation with heparin. Therefore, criteria other than imaging studies or immediate defervescence following heparin therapy are necessary for diagnosis of septic pelvic thrombophlebitis. A more appropriate terminology for septic pelvic thrombophlebitis should be refractory postpartum fever of undetermined etiology.

Septic pelvic thrombophlebitis or refractory postpartum fever of undetermined etiology

The objective of this study was to review and characterize the presentation, diagnostic dilemmas, management, and prognosis of postpartum septic pelvic thrombophlebitis. Medical records of postpartum women with the diagnosis of septic pelvic thrombophlebitis were reviewed for the 8-year period 1986–1994. Cases of documented ovarian vein thrombosis or those with other pelvic pathology on imaging study were excluded. Thirty-one women, four following vaginal delivery and 27 following cesarean delivery, with a final diagnosis of septic pelvic thrombophlebitis were identified. All patients demonstrated refractory febrile morbidity (mean 5.5 ± 1.9 days prior to instituting heparin therapy) despite multiagent antimicrobial therapy with ampicillin, gentamicin, and clindamycin. Imaging studies (CT and/or ultrasound) were performed in 20 women and revealed no pelvic pathology. The patients required an average of 4.7 ± 2.1 days (median 5, range 1–9 days) of heparin therapy before defervescence. Heparin levels were therapeutic at a mean of less than 24 h (range 6–24 h). The average dose of heparin required was 16.0 ± 3.0 U/kg/h. Nine women had 13 subsequent pregnancies without recurrent thromboembolic complications. Currently available imaging studies cannot diagnose the entity we now define as septic pelvic thrombophlebitis (once cases of ovarian vein thrombosis are excluded). Our findings do not support the time-honored rule that septic pelvic thrombophlebitis responds within 24–48 h to therapeutic anticoagulation with heparin. Therefore, criteria other than imaging studies or immediate defervescence following heparin therapy are necessary for diagnosis of septic pelvic thrombophlebitis. A more appropriate terminology for septic pelvic thrombophlebitis should be refractory postpartum fever of undetermined etiology. © 1996 Wiley-Liss, Inc.

Unusual course of the gonadal vein: a case report of postpartum ovarian vein thrombosis mimicking acute appendicitis clinically and sonographically.

Unusual course of the gonadal vein: a case report of postpartum ovarian vein thrombosis mimicking acute appendicitis clinically and sonographically.

Pseudothrombosis of the right ovarian vein pitfall of abdominal spiral CT

We present the computed tomography (CT) findings of pseudothrombosis of the right ovarian vein. In two young multiparous women, pseudothrombosis was detected on early-phase spiral CT scans by the presence of retrograde flow of contrast medium down the left ovarian veins. Asymmetry of density seen in the ovarian veins in the early phase of spiral CT scanning related to reflux in the left ovarian vein should not be mistaken for right ovarian vein thrombosis.

Postpartum ovarian vein thrombosis after vaginal delivery: A report of 11 cases

To review and characterize the presentation of postpartum ovarian vein thrombosis after vaginal delivery. We reviewed medical records of patients with the prior diagnosis of septic pelvic thrombophlebitis, deep vein thrombosis, and pulmonary embolism associated with pregnancy. The study covered the 10-year period from July 1984 through August 1994 and included women hospitalized at E.H. Crump Women's Hospital, Regional Medical Center, University of Tennessee, Memphis, Tennessee. During the study period, there were 76,858 deliveries: 13,109 cesareans and 63,749 vaginal deliveries. Eleven patients had documented postpartum ovarian vein thrombosis after vaginal delivery. Ten patients were readmitted an average of 7.6 days after delivery (range 3-17). The diagnosis was documented by computed tomography (CT) scan or ultrasound in ten women and laparotomy in one. Nine patients were readmitted with the presumptive diagnosis of endometritis, the other two with the presumptive diagnosis of pyelonephritis. Nine were treated initially with ampicillin, gentamicin, and clindamycin. Heparin therapy was added when failure of clinical response was noted. No patient defervesced within 24 hours of beginning heparin therapy; only two patients defervesced within 48 hours, and the remaining patients became afebrile at an average of 6.8 days (range 4-18, median 5). The diagnosis of ovarian vein thrombosis should be considered early in the care of patients readmitted with a diagnosis of endometritis after vaginal delivery. If prompt defervescence does not occur with aggressive intravenous antibiotic therapy, a CT scan should be obtained in a timely manner for prompt diagnosis and therapy. Our findings do not support the time-honored rule that septic pelvic thrombophlebitis and ovarian vein thrombosis respond within 24-48 hours to therapeutic anticoagulation with heparin.

Postpartum ovarian vein thrombosis

Ovarian vein thrombosis is a rare occurrence in the postpartum period. Two cases of postpartum ovarian vein thrombosis are presented. The differential diagnosis is extensive because many diseases can present with similar symptoms. Early diagnosis is essential for appropriate treatment and prevention of the potential sequelae that can occur. Computerized tomography with contrast is the optimal imaging modality for the diagnosis.