At the Viewbox: Ovarian Vein Thrombosis

A 50-year-old woman presented as an outpatient for follow-up imaging after completing chemotherapy and radiation for rectal adenocarcinoma. A contrast-enhanced computed tomography (CT) examination of the abdomen and pelvis was performed, which demonstrated a new long segment filling defect within the left ovarian vein (arrows, A and B), consistent with ovarian vein thrombosis. No surrounding inflammatory stranding was noted.

Isolated ovarian vein thrombosis is an important, although rare, etiology of abdominal and pelvic pain. Risk factors for ovarian vein thrombosis include pregnancy, pelvic inflammatory disease, recent gynecologic surgery, malignancy, chemotherapy, and trauma.¹ Often, it presents as thrombophlebitis in pregnant or postpartum women experiencing abdominal pain and fever of unknown origin.

CT with IV contrast is the study of choice, demonstrating a low attenuation filling defect within the ovarian vein.² A thickened enhancing vessel wall and surrounding inflammatory stranding may also be present, particularly in cases of thrombophlebitis. Ovarian vein thrombosis typically requires anticoagulation treatment to prevent propagation of a clot or distal emboli. Antibiotic therapy is necessary if thrombophlebitis is suspected.¹

References

1. Harris K, Mehta S, Iskhakov E, et al. Ovarian vein thrombosis in the nonpregnant woman: an overlooked diagnosis. Ther Adv Hematol 2012;3(5):325-328.
2. Karaosmanoglu D, Karcaaltincaba M, Karcaaltincaba D, et al. MDCT of the ovarian vein: normal anatomy and pathology. Am J Roentgenol 2009;192:295-299.