Postpartum ovarian vein thrombosis and venous anatomical variation

Abstract

A 34-year-old multipara presented 72 hours postpartum with acute right-sided abdominal pain. The investigation revealed mild leucocytosis with positive D-dimer and elevated C reactive protein. Abdominal ultrasound and abdominopelvic CT demonstrated an enlarged right ovarian vein with endoluminal thrombus, representing postpartum ovarian vein thrombosis. The patient became asymptomatic 48 hours after starting broad-spectrum antibiotic treatment and anticoagulant therapy. She completed the treatment in ambulatory regimen and control abdominopelvic CT imaging was performed and revealed a duplicated right ovarian vein and a small residual subacute thrombus in the lumen of the distal right ovarian vein. The patient remained asymptomatic in the clinical follow-up.

Keywords: gynecology; pregnancy; radiology.

Figure 1

Ultrasound image of the right adnexal region depicting a hypoechoic tubular structure representing the thrombosed right ovarian vein.

Figure 2

Abdominopelvic CT scan with iodine contrast illustrating the marked dilatation and tortuosity of the right ovarian vein (solid arrows), with lack of endoluminal enhancement, representing acute ovarian vein thrombosis.

Figure 3

Follow-up abdominopelvic CT scan with iodine contrast detailing the residual endoluminal thrombus (solid arrow) in the inferior segment of the right ovarian vein.

Figure 4

Maximum intensity projection coronal view of follow-up abdominopelvic CT scan with iodine contrast portraying the duplication (solid and open arrows) of the right ovarian vein.