Season 8 Case 27

Season 8 Mar 5, 2020

History: abdominal pain

Can you find the diagnosis on this non-contrast exam?

Answer: Right ovarian vein thrombosis (possibly thrombophlebitis)

Note the dilated, hyperdense right ovarian veins. Stranding suggests phlebitis (check with labs)

Blue arrow denotes the dilated, hypderdense ovarian veins.

Remember the anatomy - R gonadal vein drains into the IVC while the L gonadal vein drains into the L renal vein More inferiorly you can see the abnormal veins surrounding the right ovary.

Classic patient is ~1 wk postpartum with fever and RLQ pain. Non-OB/GYN tend to think appendicitis but this is not a rare postpartum complication so always check out the veins when you can - even on a non-contrast exam!