AJR 2003; 181:1430-1431
© American Roentgen Ray Society
Detection of Pulmonary Emboli Resulting from Ovarian Vein Thrombosis
Wael H. Benfayed,
William C. Torreggiani and
Samuel Hamilton
Adelaide and Meath Hospital Dublin 24, Ireland
A 49-year-old woman was admitted to our hospital after having an
MRI-confirmed infarct in the territory of the left middle cerebral artery.
Results from a complete workup, including echocardiography, ECG monitoring,
and Doppler sonography of the carotid artery, were all negative. The patient
was treated conservatively, and her symptoms gradually improved. One week
later, she developed acute chest tightness and dyspnea. An analysis of blood
gases indicated hypoxemia, and a provisional diagnosis of pulmonary embolism
was made. The findings of chest radiography were normal.
Ventilation–perfusion scans revealed multiple left-sided peripheral
defects and confirmed the diagnosis of pulmonary embolism with a classic
pattern of ventilation–perfusion mismatch (Figs.
1A and
1B).
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Fig. 1A. —49-year-old woman with acute chest tightness and dyspnea 1
week after treatment of infarct in left middle cerebral artery territory.
Anteroposterior radionuclide ventilation–perfusion scan reveals multiple
left-sided peripheral defects.
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Fig. 1B. —49-year-old woman with acute chest tightness and dyspnea 1
week after treatment of infarct in left middle cerebral artery territory.
Anteroposterior radionuclide ventilation–perfusion scan confirms
mismatch, which is consistent with pulmonary embolism.
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To find the source of pulmonary emboli, we performed Doppler sonography on
the veins in the lower limbs and obtained normal results. Sonographic findings
in the abdomen and pelvis (including the inferior vena cava) were normal. A 3D
gadolinium-enhanced fast low-angle shot MR angiogram was then obtained in the
coronal plane to allow evaluation of the deep veins of the pelvis. Imaging was
performed on a 1.5-T scanner (Siemens, Erlinger, Germany), using an infusion
technique. Source MR angiograms and multiple-intensity-projection images were
reviewed. The pelvic veins and inferior vena cava appeared normal. However, we
identified a filling defect in a large left ovarian vein on both MR angiograms
and maximum-intensity-projection images (Figs.
1C and
1D). We believed that this
defect was the most likely source of the pulmonary emboli. The patient was
placed on anticoagulant therapy and recovered with no complications.
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Fig. 1C. —49-year-old woman with acute chest tightness and dyspnea 1
week after treatment of infarct in left middle cerebral artery territory.
Coronal 3D gadolinium-enhanced fast low-angle shot MR angiogram (source image
for D) shows thrombus (arrow) in left ovarian vein.
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Fig. 1D. —49-year-old woman with acute chest tightness and dyspnea 1
week after treatment of infarct in left middle cerebral artery territory.
Maximum-intensity-projection image shows thrombus (arrow) in ovarian
vein.
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Ovarian vein thrombosis is a rare but well-recognized clinical entity
[1]. It may be more common than
previously thought; with the advent of cross-sectional imaging, the diagnosis
has been made more frequently
[2]. Classically seen during
the postpartum period [1,
3], ovarian vein thrombosis has
also been described in association with inflammatory disease and as a
complication of pelvic surgery
[1]. The condition is often
clinically difficult to distinguish from endometritis, appendicitis, or
pyelonephritis [1]. Ovarian
vein thrombosis may extend into the renal veins and the inferior vena cava and
is potentially fatal [1].
On CT, typical findings are the presence of a tubular retroperitoneal mass
in the position of the ovarian vein
[4]. The diagnosis is most
confidently made on contrast-enhanced imaging. On sonography, the appearance
of ovarian vein thrombosis has been described as an enlarged vein with a
central filling defect and lack of Doppler flow
[4]. The condition has also
been described on MRI [4],
which we find superior in its depiction if a maximum-intensity-projection
protocol is used.
References
- Hippach M, Meyberg R, Villena-Heinser S, Mink D, Eaton AK.
Postpartum ovarian vein thrombosis. Clin Exp Obstet
Gynecol 2000;27:24
–26[Medline]
- Simons GR, Piwnica-Worms DR, Goldhaber SZ. Ovarian vein thrombosis.
Am Heart J 1993;26
: 641–647
- Quane LK, Kidney DD, Cohen AJ. Unusual cases of ovarian vein
thrombosis as revealed by CT and sonography. AJR1988; 171:487
–490
- Savader SJ, Otero RR, Savader BL. Puerperal ovarian vein
thrombosis: evaluation with CT, US, and MR imaging.
Radiology1988; 167:637
–639[Abstract/Free Full Text]
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