Fact-sheet: Ovarian vein thrombosis
Updated on 09/27/2019 at 4:15 PM
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Definition
Obstruction of the ovarian vein by a thrombus, most often bland (cruoric), more rarely tumoral.
Ovarian vein:
- Courses for 3 to 4 cm along the psoas muscle, normal caliber 3 to 4 mm
- Drains lateral elements of the internal genital tract: fallopian tubes / ovaries / round ligament
- Drains into the IVC on the right and into the renal vein on the left, at the level of L2
Clinical features
Risk factor:
- pregnancy / delivery / postpartum period
- complication of uterine fibroids
- complication of pelvic infection/surgery
Variable clinical presentation:
- Painful presentation mimicking appendicitis (RLQ pain and fever). Right-sided thrombosis in 80% of cases
- Nonspecific abdominal pain syndrome
- Pelvic pain
- Psoitis
- MAY BE ASYMPTOMATIC
Laboratory findings
Elevated thrombotic markers (D-dimers) as in any thromboembolic disease.
Biological inflammatory syndrome
Radiography
Not contributory
Ultrasound
Doppler ultrasound:
- Loss of flow in the vein
- Visualization of the thrombus (adnexal "mass syndrome" extending toward the IVC)
- Extension to the renal vein and IVC
- Often hindered by bowel loops
CT
Reference examination:
- Floating thrombus, possibly spontaneously hyperdense
- Dilated vein
- Infiltration of the periureteral fat along its course
- Development of a collateral pelvic varices network
- Extension to the renal vein/IVC/pulmonary embolism
MRI
Endoluminal filling defect within the dilated venous axis
Management
Prevention and elimination of risk factors
Anticoagulant therapy (risk of pulmonary embolism)
Differential diagnosis
Acute Appendicitis
Any cause of poorly localized abdominal pain (digestive, urologic, gynecologic, obstetric, musculoskeletal)