MyPACS.net: Radiology Teaching Files > Case 5561718

never visited GONADAL VEIN THROMBOSIS
Contributed by: Erin Cooke.
Patient: 71 year old female
History:

71 yo female with weight loss.

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Findings:

Incidental note is made of a partially thrombosed right gonadal vein. There is no extension of thrombus evident within the right renal vein or cava.

Diagnosis: Right ovarian vein thrombosis
Discussion:

Ovarian vein thrombosis is an uncommon but potentially serious disorder associated with a variety of pelvic conditions, most notably recent childbirth. Ordinarily an incidental finding, ovarian vein thrombosis becomes serious when complicated by infection (ie, thrombophlebitis).

Pathophysiology: Ovarian vein thrombosis arises out of the coincident conditions of venous stasis and hypercoagulability and commonly is present in the recently postpartum patient. Other conditions associated with hypercoagulability, such as recent surgery, malignancy, and Crohn disease, also elevate the patient's risk for ovarian vein thrombosis.
Frequency:

  • In the US: Ovarian vein thrombosis occurs with 0.02-0.18% of pregnancies and is diagnosed 80-90% of the time on the right side in affected postpartum patients.
  • Internationally: International frequency figures are not available.
Mortality/Morbidity: Complications include ovarian vein thrombophlebitis, resulting in sepsis; thrombosis of the inferior vena cava and renal veins, resulting in pulmonary embolism (25%); and death (5% of complicated cases, estimated 18 deaths per million pregnancies).

Race: Ovarian vein thrombosis has no racial predilection.

Sex: Ovarian vein thrombosis is observed almost exclusively in females. Although thrombosis of the gonadal vein can occur in male patients with malignancy and other hypercoagulable conditions, thrombophlebitis with serious complications is rare in men.

Age: Ovarian vein thrombosis can occur in females of any age, but postpartum ovarian vein thrombosis logically occurs in women of childbearing age.

Anatomy: The ovarian veins form a plexus near the ovary within the broad ligament and communicate with the uterine plexus. These veins ascend in the retroperitoneum adjacent to the psoas muscle in pairs, which combine to form a single vein prior to termination. The right ovarian vein terminates in the inferior vena cava at an acute angle. The left ovarian vein terminates in the left renal vein at a right angle. Occasionally, valves are present in the ovarian veins. The veins enlarge greatly during pregnancy to accommodate increased blood volume. Following childbirth, a period of venous stasis occurs.

Clinical Details: The typical patient with clinically significant ovarian vein thrombosis (ie, thrombophlebitis) presents with pelvic pain, fever, and a right-sided abdominal mass. Anticoagulant and intravenous (IV) antibiotic therapy is the treatment of choice. Note that patients who have undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy with retroperitoneal lymph node dissection often demonstrate ovarian vein thrombosis on contrast-enhanced CT. No treatment is necessary in patients in whom the complications of thrombophlebitis or embolism do not occur.

Preferred Examination: Ultrasound (US), CT, and MRI are the best radiologic modalities for making the diagnosis. US can provide a quick and inexpensive initial examination, without risk to the patient. However, US frequently is limited because of overlying bowel gas. Other cross-sectional modalities (CT, MRI) are more sensitive and specific alternatives, but are more time consuming and expensive. Using MRI allows the examiner to avoid ionizing radiation and the need for IV iodinated contrast material. CT can be obtained more easily than MRI at most institutions.

References: http://www.emedicine.com/radio/byname/ovarian-vein-thrombosis.htm
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Additional Details:

Case Number: 5561718Last Updated: 08-11-2006
Anatomy: Genitourinary (GU)   Pathology: Vascular
Modality: CTExam Date: Access Level: Readable by all users
Keywords: thrombosis

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