Diagnosis and management of ovarian vein thrombosis in a healthy individual: a case report and a literature review

Abstract

Ovarian vein thrombosis (OVT) is a rare condition most often seen in the immediate postpartum period. We report a 40-year-old woman with no significant past medical or surgical history who presented to the emergency room for acute right lower quadrant pain of 1 day duration. A computed tomography (CT) scan showed a normal appendix but a new finding of right ovarian venous thrombosis. To date, only nine cases of idiopathic OVT have been reported. In this case report, we present a summary of these cases and review of literature regarding management of OVT.

Idiopathic Bilateral Ovarian Vein Thrombosis in a Non-Pregnant Healthy Patient: A Case Report and Review of the Literature

“…In one of the reported cases, the patient had polycystic ovarian syndrome (PCOS) and recent use of oral contraceptive (OCP), which had been discontinued eight weeks before the presentation [9], while in another reported case, the patient had a recent history of pelvic inflammatory disease with evident bilateral hydrosalpinx and had undergone bilateral laparoscopic salpingectomy three weeks before the presentation, contributing to significant risk factors [10]. One more patient had experienced recent significant trauma, and even at the time of presentation with OVT, had healing bruises at the abdominal wall [5].…”

“…Doppler ultrasound (DUS) remains the first choice, as it is non-invasive, inexpensive, and readily available in the emergency department. However, it is operator-dependent, and body habitus, overlying structures, and bowel gas patterns can interfere with imaging [4,5]. The sensitivity of the DUS is around ~50% only [5].…”

“…However, it is operator-dependent, and body habitus, overlying structures, and bowel gas patterns can interfere with imaging [4,5]. The sensitivity of the DUS is around ~50% only [5]. Also, DUS cannot examine the whole length of the ovarian veins [2].…”

Sex‐specific differences in the presenting location of a first venous thromboembolism

“…Thrombi could also be formed at yet another sex‐specific anatomic site, such as the ovarian or uterine veins, and embolize to the lungs, and hence not lead to symptoms of DVT. Ovarian vein thrombosis is rare, although symptoms are often ambiguous and diagnosis is difficult with imaging without contrast . Furthermore, another possible explanation could be that, in women, an asymptomatic May–Turner syndrome with silent proximal DVT is more prevalent than in men.…”

“…Thrombi could also be formed at yet another sex-specific anatomic site, such as the ovarian or uterine veins, and embolize to the lungs, and hence not lead to symptoms of DVT. Ovarian vein thrombosis is rare, although symptoms are often ambiguous and diagnosis is difficult with imaging without contrast [35,36].…”