The musk shrew, Suncus murinus, is a unique animal model for the study of female behavioral endocrinology, and by utilizing the physiological characteristics of ovulation during mating of S. murinus, key progress has been made in the study of the endocrine regulatory function of the ovary. The study of innervation of the ovary of S. murinus is particularly important. In the present study, the 3-dimensional structure of the neural innervation of the internal genital organs of S. murinus (n=11, female) was studied using whole-mount immunohistochemical staining with neurofilament protein antibodies. The innervation of the ovary in S. murinus contains the superior ovarian nerve, which runs along the suspensory ligament of the ovary, and the ovarian plexus nerve, which runs along the ovarian artery and vein. The innervation of the uterus originates from the lower hypogastric plexus running in the pelvic peritoneum and along the uterine artery and vein. There was abundant communication between the ovarian plexus nerve and the lower hypogastric plexus of the pelvic peritoneum. The present study is the first to visualize the (NFP-positive) innervation of the female internal genital organs of the experimental animal S. murinus by the whole-mount immunohistochemistry method. The abundant communication between the ovarian plexus nerve and the lower hypogastric plexus of the pelvic peritoneum provides an additional pathway for the neural regulation of the ovary.

A case of postpartum ovarian vein thrombophlebitis diagnosed by CT

Acute non-traumatic pelvic pain represents a frequent and complex diagnostic dilemma in pre-menopausal females presenting to the emergency department due to overlapping symptomatology across pregnancy and non-pregnancy related causes. Radiologists play a pivotal role in expediting accurate diagnosis and guiding appropriate management in these potentially life-threatening scenarios. This review provides an approach to workup and imaging selection in these patients, emphasizing the necessity of serum β-hCG testing and the central role of transabdominal and transvaginal pelvic ultrasound. An overview of female pelvic anatomy is provided. Using a multimodality imaging approach, early pregnancy related complications such as ectopic pregnancy, retained products of conception, and gestational trophoblastic disease and non-pregnancy related causes of acute pelvic pain such as ovarian torsion, ruptured ovarian cysts, pelvic inflammatory disease, endometriosis, uterine vascular malformation, ovarian vein thrombosis, ovarian hyperstimulation syndrome, and intrauterine device complications are reviewed. Finally, we propose an algorithmic approach to imaging selection and interpretation tailored to the clinical scenario, laboratory findings (notably β-hCG status), and patient demographics. This structured framework aims to support radiologists in efficiently narrowing the differential diagnosis and optimizing patient outcomes in acute, non-traumatic pelvic emergencies.

Female pelvic congestion syndrome is associated with chronic pelvic pain and affects approximately 30% of women. There are no formal diagnostic criteria to assist with the diagnosis of pelvic congestion syndrome despite affecting such a large proportion of the population. Furthermore, the aetiology and anatomy of pelvic congestion syndrome has significant overlap with the causal factors of varicoceles in men, many of whom also experience chronic pain/aching. However, women are at greater risk of developing venous damage associated with pelvic congestion syndrome due to hormonal changes and pregnancy, both of which exacerbate pelvic congestion syndrome and its causes. A narrative review methodology was utilised to search for literature discussing ultrasound and its role in the diagnosis of pelvic congestion syndrome. The search used two databases and explored 'grey' literature published between 2014 and 2024. Sensitivities and specificities of diagnostic criteria proposed have been reported as well as other metrics which may be utilised in the ultrasound diagnosis of pelvic congestion syndrome. Ultrasound appearances associated with pelvic congestion syndrome include dilated pelvic veins, specifically; the left ovarian vein, adnexal veins, and intrauterine/myometrial veins. There are, however, few high-quality comparative studies assessing the accuracy of different venous diameter cut-off values which may be used in the diagnosis of pelvic congestion syndrome. Other ultrasound findings cited commonly include slow venous flow of less than 3 cm per second and demonstrable venous reflux on Valsalva manoeuvre. Currently there are insufficient data to conclude formal diagnostic ultrasound criteria for pelvic congestion syndrome. Existing evidence supports a multifaceted diagnostic approach and ultrasound practitioners must be mindful of patients' clinical history and potential associated ultrasound features to avoid underdiagnosis of this common condition. In the meantime, further primary research is needed before the full value of ultrasound can be understood.

Circulating tumour cells (CTCs) are rare yet crucial biomarkers with significant prognostic potential across different cancer types. However, their role in high-grade serous ovarian cancer (HSGC) is not well defined. To capture the full spectrum of CTCs found in HGSC, we employed an EpCAM independent enrichment technique in patients with advanced HGSC and investigated the prognostic value and molecular signatures of these rare cells. CTC enumeration was performed in 43 newly diagnosed patients with HGSC using Parsortix® CTC enrichment and benchmarked against a metastatic breast cancer (MBC) cohort for which the device is FDA approved. CTCs were also isolated from the ovarian vein of patients with HGSC during primary cytoreductive surgery. CTCs were assessed as prognostic markers in patients with HGSC. FACS single cell sorting and scRNAseq was performed on CTCs isolated from the ovarian vein. CTCs isolated using Parsortix® enrichment in HGSC ranged between 1-22 cells/7.5 ml blood. Concordance was seen between Parsortix® enrichment and CellSearch® enumeration in patients with MBC (R2 = 0.8786). CTC clusters were isolated from the ovarian vein (P = 0.0195) and were cloaked in platelets/immune cells. Detection of CTCs in patients with HGSC was predictive of a poorer progression free survival (P = 0.0183). Patients with CTCs were found to have increased serum levels of CD73 (P = 0.0311). scRNAseq of CTCs isolated from the ovarian vein identified enrichment in genes associated with immune signalling. Peripheral CTCs isolated from patients with HGSC were predictors of a poor prognosis. The ovarian vein was found to be a rich source of disseminating CTC clusters in HGSC. Further studies are warranted to investigate the utility of CTCs as markers of neoadjuvant chemotherapy response as well as for longitudinal monitoring. Molecular analysis of CTCs in HGSCs reveals a potential role of the immune system in CTC-mediated haematogenous metastasis.

Nutcracker syndrome (NS) is a rare pathology that occurs when the left renal vein (LRV) is compressed between the aorta and the superior mesenteric artery. This anomaly is rarely diagnosed due to low awareness and polymorphism of clinical manifestations, but the consequences of phlebohypertension in the left renal vein system (left-sided varicocele, left-sided pudendal varices, hematuria, proteinuria and, in some cases, renal failure) constitute a significant medical and social problem. Right-sided NS is an even rarer variant of the group of abdominal vascular compression syndromes (AVCS). Pregnancy is a determining factor contributing to right-sided NS due to extravasal compression of the right renal vein by the gravid uterus. The aim of our study was to analyze an unusual clinical case of right-sided NS with an atypical clinical picture, which confirms the need for physicians to be aware of AVCS. An example of a complex diagnosis of right-sided NS with an atypical clinical manifestation in a 24-year-old patient who was urgently hospitalized in the surgical department with a clinic of acute appendicitis on the 3rd day after delivery is presented. The patient underwent a preoperative ultrasound examination of the abdominal cavity and pelvic organs – multiple hypoechoic masses in the right iliac region measuring 1.5 – 1.7 cm were visualized. Intraoperatively, a large varicose, tortuous, thrombosed right ovarian vein was verified, which was removed in its entirety along with the right appendages. The postoperative period was without complications. She was discharged on the 7th day. According to the control ultrasound examination on the 5th day after the intervention, no pathology was detected. There are no clinical symptoms in the long-term postoperative period. Pelvic phlebostasis is a pathology that occurs mainly in women of reproductive age, but to date there is no data on its impact on the occurrence of idiopathic forms of infertility, pregnancy, the course of childbirth, the occurrence and course of gynecological pathology. It is known that pelvic varicose veins not only accompany various gynecological diseases, but also cause chronic pelvic pain (pelvic congestion syndrome). Pelvic varices have until now been more often considered an incidental diagnostic finding. At a young age, asymptomatic forms of the disease are more often diagnosed, in which organic changes in the venous system of the small pelvis are detected only when using additional research methods. At the same time, about 10 % of gynecological patients suffer from chronic pelvic pain. These patients have been unsuccessfully examined and treated for years for chronic inflammatory processes of the appendages, genital endometriosis. According to various data, the cause of pelvic venous congestion in 74 % of cases is NS, in 17 % – May-Turner syndrome, in 9 % – a combination of these two causes. The pronounced polymorphism of clinical manifestations significantly complicates the diagnosis and management of vascular compression syndromes, decompensated forms of pelvic venous congestion require a multidisciplinary approach and timely adequate surgical treatment.

Nutcracker syndrome: A novel endovascular anchoring technique for left renal vein stenting.

Endovascular management of pelvic congestion syndrome: An expert consensus statement from the French Society of Cardiovascular Imaging (SFICV), Interventional Radiology Federation (FRI), College of French Radiology Teachers (CERF), and French Society of Women's Imaging (SIFEM).

Non-contrast MRI diagnostic protocol for pelvic venous disorders.

Relevance: Pelvic venous congestion syndrome (PVCS) is a chronic and often underdiagnosed vascular disorder in women of reproductive age, primarily manifested by persistent pelvic pain. Impaired venous outflow, characterized by reflux and dilatation of ovarian and pelvic veins, is considered the primary mechanism. Endovascular embolization has emerged as a safe, minimally invasive treatment that provides significant symptom relief. The study aimed to evaluate the efficacy and safety of endovascular ovarian vein embolization in women diagnosed with pelvic venous congestion syndrome. Materials and Methods: A retrospective analysis included 17 women (18–50 years) with clinically and radiologically confirmed PVCS who underwent ovarian vein embolization at the Syzganov National Scientific Center of Surgery (Almaty, Kazakhstan) in 2023–2024. Diagnosis was based on Doppler ultrasound, CT venography, and catheter-based phlebography. Embolization was performed using coils and sclerosing agents. Pain intensity was evaluated by the Visual Analog Pain Scale (VAPS) before and after surgery (Day 1, Day 3, 1 month, 3 months). Statistical analysis was performed using the Wilcoxon signed-rank test, with p < 0.05 considered significant. The article also presents a clinical case of PVCS with pelvic varicose vein disease. Results: Ovarian vein reflux (Hiromura grade II-III) was detected in 88.2% of patients, predominantly on the left side. VAPS scores decreased from a median of 6.0 (IQR 5-7) preoperatively to 2.0 (IQR 1-3) at 3 months (p < 0.001). No major peri- or post-procedural complications occurred. Three women (17.6%) required re-embolization due to contralateral reflux. Overall, 82.4% of patients reported partial or complete symptom resolution. Conclusions: Endovascular ovarian vein embolization is a safe and effective treatment for PVCS, resulting in long-term reductions in pelvic pain and improvements in quality of life. Integration of multidisciplinary diagnostic criteria and SVP classification may further optimize patient selection and outcomes.

Background: Postpartum ovarian vein thrombophlebitis (POVT) is a rare yet potentially life-threatening complication. This study assesses the diagnostic utility of clinical manifestations and semi-quantitative parameters derived from non-contrast computed tomography (CT). Methods: A total of 34,140 postpartum patients at People’s Hospital of Yuxi City from December 2017 to October 2024 were included. Among them, only 24 POVT cases and 42 non-POVT puerperal women had complete clinical and CT datasets. In both groups, the CT attenuation values of the ovarian vein (OV) and inferior vena cava (IVC), OV diameter, CT attenuation difference (OV CT value minus IVC CT value), and OV/IVC attenuation ratio (OV CT value divided by IVC CT value) were recorded. Comparisons were made between the two groups regarding D-dimer levels, OV width, CT attenuation values, and OV/IVC attenuation ratio. Data were analyzed using SPSS version 27.0, the chi-square test, or the Mann-Whitney U test conducted at a significance level of <0.05. Results: D-dimer levels were significantly higher in the POVT group (7.66 ± 4.94 vs. 1.94 ± 0.91 μg/mL, p < 0.01). Semi-quantitative non-contrast CT metrics showed strong diagnostic performance: OV width ≥0.90 cm (sensitivity 91.70%, specificity 95.20%), thrombus CT value ≥46.00 HU (sensitivity 100%, specificity 100%), CT attenuation difference ≥12.50 HU (sensitivity 95.30%, specificity 100%), and OV/IVC attenuation ratio ≥1.10 (sensitivity 95.30%, specificity 100%) clearly distinguished POVT from non-POVT patients (p < 0.01). Conclusions: Non-contrast CT provides a valuable imaging modality for identifying POVT. D-dimer levels, combined with semi-quantitative CT parameters—OV width, thrombus CT value, CT attenuation difference, and OV/IVC attenuation ratio—can significantly improve diagnostic precision.

We report a genital tract Fusobacterium necrophorum and Streptococcus anginosus postpartum infection causing Lemierre's syndrome in a 17-year-old female. This resulted in sepsis, endomyometritis, oophoritis, thrombosis of the right ovarian vein, thrombocytopenia and hysterectomy. Prompt recognition leading to aggressive medical/surgical management of postpartum infection is vital to preserve fertility.

Paradigm shift and long-term results in the diagnosis and treatment of pelvic venous disorder

Efficacy and safety of ovarian vein embolization with N-butyl-2 cyanoacrylate for pelvic venous disorder: Analysis of 100 cases.

Rationale:Ovarian varicocele is a rare yet long-lasting disease in female. Endovascular interventional embolization therapy is the recommended treatment for ovarian varicocele; however, existing embolic materials are prone to causing reocclusion and recurrence of ovarian varicose veins. This study aims to assess the efficacy of vascular plugs in embolizing ovarian varicoceles, thereby providing a novel treatment option for ovarian varicose veins.Patient concerns:A 42-year-old middle-aged woman was admitted to the vascular surgery department due to persistent lower abdominal distension and pain for half a year.Diagnoses:Preoperative full abdominal enhanced CT revealed bilateral ovarian varicocele, while abdominal vascular ultrasonography showed no evidence of nutcracker syndrome.Interventions:Interventional strategy: injection of sclerosing agent into the distal branch vessels and placement of uncontrolled coils, and placement of type II vascular plug in the proximal main trunk vessels.Outcomes:The vascular embolization procedure was successfully performed. Intraoperative angiography confirmed the absence of blood reflux in the ovarian vein, and follow-up enhanced abdominal CT scans at 3 months post-operation revealed no evidence of recanalization in the ovarian vein. No adverse events were reported during the operation, and the radiation exposure time was minimal. The absence of complications during the perioperative period indicates that this method is safe. Furthermore, there was a significant improvement in postoperative abdominal pain.Lessons:This innovative method offers a safe and efficacious alternative therapeutic option for patients suffering from ovarian varicose vein.

The ovarian veins (OVs) are paired vessels that drain deoxygenated blood from the ovaries, fallopian tubes, and adjacent pelvic structures. The objective of this study is to systematically synthesize cadaveric and imaging-based data to describe the anatomy, variations, and clinical relevance of the OVs. To conduct this meta-analysis, a systematic literature search was carried out to identify all studies concerning the anatomy of the ovarian vein. Searches were performed in major medical databases, including PubMed, Scopus, Embase, Web of Science, Google Scholar, and the Cochrane Library. A total of 35 studies were included in this meta-analysis. The overall mean diameter of the OV was estimated at 4.88 mm (SE = 0.24). The diameter of the right OV reached 4.44 mm (SE = 0.28), while the left OV measured 4.99 mm (SE = 0.34). The pooled prevalence of valves in the ovarian veins was calculated at 91.93% (95% CI: 83.32-97.79%). Competent valves were found in 72.16% of cases (95% CI: 58.72-83.89%), while incompetent valves were present in 27.84% (95% CI: 16.11-41.28%). On the right side, a double OV was present in 1.00% of specimens (95% CI: 0.00-3.08%). On the left, this variation occurred slightly more frequently, with a pooled prevalence of 2.08% (95% CI: 0.43-4.72%). This meta-analysis highlights critical anatomical and clinical features of the ovarian veins. The left OV is wider and more frequently incompetent than the right, supporting the left-sided predominance of pelvic congestion syndrome. Drainage patterns confirm classical anatomy - right OV to inferior vena cava, left OV to left renal vein - but rare variants must be considered during interventions. OV duplication, though rare, poses a risk of incomplete embolization if unrecognized. These findings underscore the need for side-specific imaging and thorough anatomical evaluation to improve diagnosis, embolization outcomes, and surgical planning in pelvic venous disorders.

No abstract available

Background: Intravascular leiomyomatosis (IVL) is a rare condition, with approximately 400 cases reported in the literature since its first description in 1896. It is characterized by the intravascular proliferation of smooth muscle cells, often with a branching pattern that can extend from pelvic veins to thoracoabdominal vessels. Although benign in histological terms, IVL can clinically mimic a malignancy and lead to potentially fatal complications. The majority of cases of IVL have been reported in women, especially in the fourth decade of life, frequently associated with uterine leiomyomas. The treatment of choice is surgical resection, aiming to reduce morbidity and mortality associated with vascular involvement and minimize the risk of recurrence. Case Report: We report the case of a 48-year-old woman who presented in December 2022 with dyspnea and palpitations. A transthoracic echocardiogram revealed a right atrial mass, prompting further evaluation. A total-body CT scan identified a large pelvic mass, likely of uterine origin, with intravascular extension involving the ovarian veins, the right internal and common iliac veins, and the inferior vena cava (IVC), reaching the right atrium. Pelvic mass biopsy confirmed a benign leiomyoma and intravascular leiomyomatosis. Following multidisciplinary discussion, the patient underwent an initial surgery to remove the tumor from the vascular structures. In June 2023, resection was performed from the atriocaval junction up to the confluence of the suprahepatic veins. Histological examination confirmed IVL. A radiological follow-up in May 2023 revealed an increase in pelvic mass size and recurrent intravascular extension to the right atrium. After re-evaluation, a three-stage surgical procedure was performed, including complete hysteroannessiectomy and tumor removal from the right iliac vein, IVC, and right atrium. The surgery was completed without complications. Postoperative histology confirmed IVL in all specimens. A follow-up CT in July, 2023 showed no residual disease, although a focal filling defect in the IVC-just above the iliac vein confluence and at the renal vein junction-suggested chemical thrombosis. The patient was started on anticoagulant therapy, which was well tolerated, without thromboembolic recurrence or major bleeding. Complete recanalization of the thrombosis was achieved. Conclusions: This case illustrates the complex and rare nature of IVL, highlighting the critical role of a multidisciplinary management for diagnosis, treatment and follow-up. Postoperative clinical and radiological follow-up is essential to detect complications such as thrombosis and especially recurrence, which occurs in 16-30% of cases, particularly when complete surgical excision is not achieved. Additional studies are needed to define standardized surgical and therapeutic protocols for the management of IVL.

A case of localized Leydig cell tumor diagnosed by bilateral ovarian vein sampling

Puerperal sepsis (PPS) is a severe postpartum infection that remains a significant maternal health concern. Recent evidence suggests a potential link between PPS and ovarian vein thrombosis (OVT), a rare but life-threatening complication occurring in 0.01 to 0.18% of pregnancies. Despite the historical significance of PPS and its well-documented consequences, its association with thrombosis remains underrecognized in obstetric practice. This narrative review explores the historical context, clinical presentation, diagnosis, and management of PPS and OVT while emphasizing the need for increased awareness and preventive strategies. Sepsis triggers a hypercoagulable state through inflammatory cytokine release, endothelial injury, and coagulation activation, contributing to thrombotic complications such as OVT. The right ovarian vein is more commonly affected due to anatomical factors, including uterine dextrorotation during pregnancy. OVT typically presents with abdominal pain and fever, requiring imaging modalities such as Doppler ultrasound and magnetic resonance imaging for diagnosis. Although anticoagulation therapy is widely used for deep vein thrombosis, its application in OVT remains inconsistent, despite comparable recurrence rates between the two conditions. The review also highlights the lack of consensus on thromboprophylaxis in septic postpartum patients. Although guidelines from major obstetric organizations are inconsistent, emerging evidence suggests that low-molecular-weight heparins may reduce thrombotic risk in PPS. In the absence of large-scale randomized trials, observational studies remain essential for guiding clinical decisions.