Imaging description

Thrombosis within the relatively small veins such as the gonadal vein, inferior mesenteric vein, upper extremity veins, and thrombosis related to a central venous catheter may be symptomatic, but can also be an incidental finding on CT or MRI. Non-occlusive venous thrombosis is typically seen on contrast-enhanced CT as an intraluminal filling defect surrounded by contrast material (Figures 95.1 to 95.3). When the vein is occluded by thrombus, the venous lumen is not opacified. Central venous catheter-related thrombosis is seen as a filling defect within the vein around or attached to the catheter (Figure 95.3).

Importance

Thrombosis in relatively small veins can be easily overlooked on routine CT examination. Ovarian vein thrombosis has been considered rare, but recent data suggested that the diagnosis is more common than previously thought with the widespread use of cross-sectional imaging. Anticoagulation is the main-stay of treatment for ovarian vein thrombosis.

The clinical significance of central venous catheter-related thrombosis remains undefined, although all thromboses have the potential to embolize, and patients often receive an anticoagu- lant therapy after detection of catheter-related thrombosis.

Typical clinical scenario

Classically, ovarian vein thrombosis predominantly occurs in the postpartum period. It is also associated with pelvic inflammatory disease, gynecological malignancy, hypercoagulability, and surgery. Clinical presentation of ovarian vein thrombosis is variable. Patients may be asymptomatic, and thrombosis may be detected incidentally on CT, particularly after hysterectomy and salpingo-oophorectomy. Other patients may present with fever and abdominal pain. Complications of ovarian vein thrombosis include extension of thrombus into the renal veins and the inferior vena cava, and pulmonary thromboembolism. In asymptomatic patients, usually no perivascular stranding is seen on CT. However, in patients with puerperal septic thrombophlebitis of the ovarian vein, tortuosity and perivascular edema are often associated. Thrombosis of the ovarian vein is more commonly seen on the right side, likely related to long length of the right ovarian vein, lack of retrograde flow, and multiple incompetent valves.

Septic thrombophlebitis of the inferior mesenteric vein can be associated with sigmoid diverticulitis.