© Springer-Verlag New York Inc. 2002
Postpartum ovarian vein thrombophlebitis: sonographic diagnosis
I. Hadas-Halpern, M. Patlas, D. Fisher
Department of Radiology, Shaare Zedek Medical Center, POB 3235, Jerusalem 91031, Israel Received: 23 February 2001/Accepted: 21 March 2001
Abstract Background: Wedescribe our experience with sonographic diagnosis of ovarian vein thrombosis, an uncommon but dangerous postpartum complication. Methods: We retrospectively reviewed the medical records of seven patients in our institution who developed postpartum ovarian vein thrombophlebitis within the past 5 years. Results: In all cases the diagnosis was made by ultrasound, which showed tubular hypoechoic masseslateral to the great abdominal vessels. The postpartum ovarian vein thrombophlebitis was on the right side in six cases and on the left side in one. In ﬁve cases, it protruded into the inferior vena cava. The ﬁrst three cases were referred to computed tomography after the sonographic diagnosis. In the last four cases, the diagnosis relied solely on sonography and no further evaluation was necessary.Conclusion: Sonographic examination can be diagnostic for ovarian vein thrombosis if performed very carefully in symptomatic postpartum patients. Key words: Thrombophlebitis—Ovarian vein—Postpartum— Ultrasonography.
ministration. False-positive CT results have been reported . We present our experience in diagnosing PPOVT by ultrasound (US) and stress the importance of recognizing thesonographic signs, as most postpartum patients with abdominal symptoms are referred primarily to US.
Patients and methods During the past 5 years, seven patients in our institution were diagnosed as having PPOVT. The age range was 22–36 years. Three patients had had vaginal delivery, and four patients had undergone cesarean section. The patients were referred to abdominal US for ﬂank pain (n 2), ﬂankpain and fever (n 2), fever (n 1), shortness of breath (n 1), and increased white blood cell count (n 1). The clinial diagnoses were ureteral obstruction (n 2), appendicitis (n 1), pyelonephritis (n 3), and deep vein thrombosis in one patient with pulmonary embolism. The US examinations were performed with an ATL Ultramark 9 (Advanced Technology Laboratories, Bothell, WA, USA) using 3.5- and7-MHz probes. Three patients also had CT (HeliCAT II, Marconi Medical Systems, Cleveland, OH, USA) examinations.
Postpartum ovarian vein thrombophlebitis (PPOVT) is an uncommon but potentially fatal situation. The incidences are 0.02– 0.15% of vaginal deliveries and 1–2% of cesarian sections . It is difﬁcult to diagnose clinically because the signs and symptoms are not speciﬁc and can mimicother, more common conditions such as ureteral obstruction, pyelonephritis, appendicitis, endometritis, or tuboovarian abscess [2, 3]. Computerized tomography (CT) is considered highly accurate in diagnosing ovarian vein thrombosis [4, 5], but it requires radiation exposure and contrast medium adCorrespondence to: I. Hadas-Halpern
Results In all cases abdominal US showed a longitudinal tubularstructure alongside the great vessels containing heterogeneous echoic material (Fig. 1). The thrombus was on the right size in six patients and in the left ovarian vein in one. In ﬁve patients the thrombus projected into the inferior vena cava in the infrarenal vein region (Fig. 2). No blood ﬂow was seen within the thrombosed veins (Fig. 3). In the three patients who also had CT, the diagnosis ofPPOVT was conﬁrmed (Fig. 4). Six patients were followed up by US and showed disappearance of the
I. Hadas-Halpern et al.: Ovarian vein thrombophlebitis
Fig. 1. Oblique sagittal sonogram shows the thrombosed right ovarian vein (arrow). Fig. 2. Sagittal (A) and transverse (B) images of the inferior vena cava show a clot extending from the right ovarian vein (OV) into the inferior vena...