Case 20
History:
74 year old woman with pelvic pain
Findings:
Enhanced abdominal CT scan showing low attenuation defect within the right gonadal vein consistent with thrombus
Diagnosis:
Right ovarian vein thrombosis
Discussion:
Gonadal vein thrombosis (GVT) is mostly observed in females. It can occur at any age but is classically found in the post partum period. In about 90 percent of the cases, it occurs on the right side. It is potentially fatal if it extends into the IVC and renal veins resulting in pulmonary embolism. GVT can clinically mimic other pathologies such as pyelonephritis and cholecystitis.
On CT the involved vein is enlarged with a central low attenuation area consistent with thrombus. US frequently is limited because of overlying bowel gas. Mild perivascular stranding may be encountered. Anticoagulant and intravenous (IV) antibiotic therapy is the treatment of choice.
