Ovarian Vein Thrombosis
Synonyms/Description
Septic pelvic thrombophlebitis (SPT)
Etiology
Ovarian vein thrombosis is a rare but potentially severe postpartum complication, occurring 80% to 90% of the time on the right side, and with a reported incidence of 1:600 to 1:2000 deliveries. Ovarian vein thrombosis can also occur in the immediate postoperative period after pelvic surgery or in conjunction with pelvic infection or thrombophilias such as factor V Leiden mutation. Spontaneous ovarian vein thrombosis without any of these predisposing conditions is exceedingly rare.
The ovarian veins are located in the retroperitoneum, anterior to the psoas muscle. The right ovarian vein is longer than the left, and it drains into the inferior vena cava below the right renal vein. The left drains into the left renal vein.
Ultrasound Findings
Ovarian vein thrombosis appears as a hypoechoic tubular mass cephalad to the ovary. Color Doppler typically shows an absence of flow within the mass.
The sensitivity, specificity, and accuracy of ultrasound with Doppler are reportedly 55.6%, 41.2%, and 46.2%, respectively. The sonographic evaluation is often limited by overlying bowel gas because the ovarian vein is a retroperitoneal structure; therefore CT with contrast is often used to make a more definitive diagnosis.
Differential Diagnosis
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