Imaging Pearls ❯ Vascular ❯ Ovarian Vein
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- Ovarian Vein Thrombosis: Risk Factors
- pregnancy: most common risk factor
- oral contraceptives
- pelvic infection
- malignancy
- recent surgery
- Idiopathic (under 6%) - Ovarian Vein Thrombosis: Pearls
- in ~80-90% of cases, the right ovarian vein is involved, possibly due to retrograde flow in the left vein preventing stasis and ascending infection
- ~14% of cases can have bilateral involvement
- ~6% of cases involve the left ovarian vein only
- tubular structure with an enhancing wall and low-attenuation thrombus in the expected location of the ovarian vein
- Right ovarian vein drains into IVC and Left gonadal vein into the left renal vein - “Ovarian vein thrombosis (OVT) is a rare type of venous thromboembolism. The most common risk factors for OVT include pregnancy, oral contraceptives, malignancies, recent surgery, and pelvic infections; however, in 4 to 16% of cases, it can be classified as idiopathic. Most of the available information regards pregnancy-related OVT, which has been reported to complicate 0.01 to 0.18% of pregnancies and to peak around 2 to 6 days after delivery or miscarriage/abortion. The right ovarian vein is more frequently involved (70-80% of cases). Clinical features of OVT include abdominal pain and tenderness, fever, and gastrointestinal symptoms. The most typical finding is the presence of a palpable abdominal mass, although reported in only 46% of cases. OVT can be the cause of puerperal fever in approximately a third of women.”
Riva N, Calleja-Agius J.
Ovarian Vein Thrombosis: A Narrative Review.
Riva N, Calleja-Agius J. Hamostaseologie. 2021 Aug;41(4):257-266. doi: 10.1055/a-1306-4327. Epub 2020 Dec 21. PMID: 33348392. - The incidence of OVT during pregnancy has been studied, particularly in the postpartum period, which was found to occur in ~1/600 to 1/2000 pregnancies . In pregnancy-related OVTs, it has been found that it usually involves the right ovarian vein (70-−90%) followed by bilateral ovarian vein involvement (11–14%). The most likely explanations for this finding are that the longer right ovarian vein lacks competent valves, the effect of the gravid uterus, and the retrograde flow in the left ovarian vein prevents stasis and ascending infection, thus making the left-sided vein less vulnerable to thrombosis.
Clinical Characteristics and Management of Ovarian Vein Thrombosis: A Case Series.
Alsheef M, Abuzied Y, Alosaimi M, et al
Front. Cardiovasc. Med. 9:916920. doi: 10.3389/fcvm.2022.916920 - “Ovarian vein thrombosis (OVT) is an uncommon condition that occurs mainly in the peripartum period. Hyper-coagulable conditions have been reported to cause OVT outside the peripartum period. The clinical presentation is usually nonspecific pain, but it can be asymptomatic in patients with underlying malignancy. Imaging plays an important role in diagnosis. Ultrasound is the initial imaging modality, but it is operator-dependent and has limited sensitivity. Computed tomography (CT) is the most commonly used modality for diagnosis. CT can show the luminal filling defect within the thrombosed vein and assess the extension of the thrombosis. MRI can show the thrombosed vein as a filling defect on post-contrast images; also, diffusion-weighted images may help in the diagnosis. Complications include extension into the inferior vena cava or renal veins. Pulmonary embolism is the most serious complication. Treatment includes anticoagulation plus antibiotics. Early diagnosis is essential to prevent complications.”
El-Diasty MT, Noorelahi Y. Imaging Findings of Ovarian Vein Thrombosis.
El-Diasty MT, Noorelahi Y.
Cureus. 2023 Nov 11;15(11):e48672. doi: 10.7759/cureus.48672. PMID: 38024035; PMCID: PMC10640670.
- “Gonadal vein thrombosis can be seen in up to 80% of asymptomatic women who undergo routine CT after hysterectomy and lymphadenectomy for neoplasm. When acute, the central thrombus typically demonstrates low attenuation and is associated with mural enhancement. The vessel chronically becomes fibrotic and contracted, and phleboliths may develop.”
Managing Incidental Findings on Abdominal and Pelvic CT and MRI, Part 2: White Paper of the ACR Incidental Findings Committee II on Vascular Findings
Khosa F et al
J Am Coll Radiol. 2013 Oct;10(10):789-94
- “Ovarian veins originate from the plexus in the broad ligament near the ovary and fallopian tubes and communicate with the uterine plexus, then course anterior to the psoas muscle and the ureter. The right ovarian vein typically drains into the IVC and the left ovarian vein into the left renal vein. Autopsy studies have shown that valves are absent in the cranial portion of the ovarian vein in 15% of women on the left and 6% on the right . The valves are incompetent on either side in 35% to 43%, with a higher frequency in multiparous women, resulting in dilation >8 mm and incompetence in many asymptomatic patients who undergo CT.”
Managing Incidental Findings on Abdominal and Pelvic CT and MRI, Part 2: White Paper of the ACR Incidental Findings Committee II on Vascular Findings
Khosa F et al
J Am Coll Radiol. 2013 Oct;10(10):789-94 - “Incompetence of the ovarian and draining pelvic veins and venous reflux are considered the main cause of pelvic congestion syndrome in women, symptoms of which include persistent dull pelvic pain lasting >6 months, dysmenorrhea, dyspareunia, postcoital ache, and urinary symptoms. However, dilated pelvic veins are often seen incidentally in asymptomatic multiparous women . If dilated pelvic veins are noted in a woman and are asymptomatic, no further imaging or intervention is recommended..”
Managing Incidental Findings on Abdominal and Pelvic CT and MRI, Part 2: White Paper of the ACR Incidental Findings Committee II on Vascular Findings
Khosa F et al
J Am Coll Radiol. 2013 Oct;10(10):789-94
- Ovarian Vein Thrombosis: causes
- Pelvic inflammatory disease
- In oncology patients
- Complication of pelvic surgery
- Clinical symptoms range from vague pain to PE, sepsis or even death - Ovarian Vein: Facts
- Right ovarian vein drains into the IVC
- Left ovarian vein drains into the left renal vein
- Ovarian veins are 3-4 mm in size
- Ovarian vein is usually anterior to the ureter "Volume-rendered images and curved planar reformatted images can be used to show the ovarian veins. MDCT findings allow the diagnosis of various ovarian vein disorders in patients with abdominal and pelvic pain, pulmonary thromboembolism, and pelvic mass."
MDCT of the Ovarian Vein: Normal Anatomy and Pathology
Karaosmanoglu D et al.
AJR 2009; 192:295-299