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Pelvic Vein Thrombophlebitis


Presentation

  • It may present as two distinct clinical syndromes: acute ovarian vein thrombosis and diffuse thrombosis of multiple small pelvic vessels. Accurate diagnosis is hampered by the absence of a reliable, specific, and noninvasive test for the disorder.[ncbi.nlm.nih.gov]
  • If bacteria that are normally present in the vagina enter the uterus, the incision from a cesarean delivery may result in endometritis, or infection of the uterus.[healthline.com]
  • We describe an unusual case of ovarian vein thrombosis presenting as back pain in a postmenopausal woman.[ijcasereportsandimages.com]
  • A 50-year-old woman presented as an outpatient for follow-up imaging after completing chemotherapy and radiation for rectal adenocarcinoma.[jaocr.org]
Fever
  • The most common symptoms include: fever chills abdominal pain or tenderness flank or back pain a “ropelike” mass in the abdomen nausea vomiting The fever will persist even after taking antibiotics.[healthline.com]
  • Septic pelvis thrombophlembitis is a cause of post-operative fever from untreated postpartum endometritis.[en.wikipedia.org]
  • A diagnostic dilemma of fever and back pain postpartum. Chest. 2001;120:1023-1024. Back To Top[appliedradiology.com]
  • Subsequent contrast-enhanced computed tomography scan in a postpartum patient with fever and bilateral ovarian vein thrombosis.[emedicine.medscape.com]
  • We report a case of postpartum ovarian vein thrombophlebitis (POVT) presenting as fever and right loin pain.[najms.org]
Falling
  • When the valves fail, the blood falls or ‘refluxes’ the wrong way down the vein, against the direction of the venous pump.[collegeofphlebology.com]
  • I immediately went to the gynecologist, and he performed an internal examination, and stated to me that he did not agree with the findings, that if I did indeed have this diagnoses, I would be falling off the table in severe pain.[hystersisters.com]
  • The limitation of this test is its lack of specificity, meaning that an elevated D-dime level can be seen in other conditions including recent surgery, fall, pregnancy, or an underlying cancer.[medicinenet.com]
  • These steps include: Preventing falls and injuries. Telling your doctors about all other medicines, supplements, and vitamins that you take. Getting regular blood tests, if your doctor tells you to.[northshore.org]
Malaise
  • Importantly, many patients will have nonspecific symptoms, including malaise, vague diffuse abdominal pain, or shortness of breath. In rare cases, a mass may be palpable, but this is an unusual finding [ 11, 12 ].[panafrican-med-journal.com]
Chills
  • The most common symptoms include: fever chills abdominal pain or tenderness flank or back pain a “ropelike” mass in the abdomen nausea vomiting The fever will persist even after taking antibiotics.[healthline.com]
Abdominal Pain
  • The most common symptoms include: fever chills abdominal pain or tenderness flank or back pain a “ropelike” mass in the abdomen nausea vomiting The fever will persist even after taking antibiotics.[healthline.com]
  • The cases are from the United States in 2012 where a 67-year- old woman was presented with a one-month history of left sided abdominal pain and from Australia in 2010 where a 42-year-old woman was presented with acute abdominal pain and nausea. [5] [6[ijcasereportsandimages.com]
  • In the postpartum period, up to 80% of patients will present with fever, but only half will experience right lower quadrant abdominal pain [ 10 ].[panafrican-med-journal.com]
  • pain and fever of unknown origin.[jaocr.org]
  • The abdominal pain is variable in presentation and may also involve the flank or back.[appliedradiology.com]
Abdominal Mass
  • The typical patient with ovarian vein thrombosis (ie, thrombophlebitis) presents with pelvic pain, fever, and a right-sided abdominal mass. [7] The combination of anticoagulant and intravenous (IV) antibiotic therapy is the treatment of choice.[emedicine.medscape.com]
  • Approximately half of cases also present with an abdominal mass. 3 Any postpartum or postoperative patient who continues to spike a fever despite antimicrobial therapy should raise suspicion for this condition. 3 This entity usually becomes apparent in[appliedradiology.com]
  • The symptoms usually presents in the first postpartum week as a syndrome consisting of pelvic pain, fever and a right-sided abdominal mass [1], [2], [6], [7], [8].[najms.org]
Tachycardia
  • Clinical signs include: fever pain on palpation of uterus midline lower abdominal pain malodorous lochia (vaginal discharge) tachycardia Laboratory results [ edit ] Septic pelvic thrombophlebitis will have elevated CRP and WBC (evidence of inflammation[en.wikipedia.org]
  • Physical exam findings may reveal fever, tachycardia, abdominal tenderness, and signs of peritonitis, all of which are nonspecific for this condition.[acepnow.com]
  • […] bloating and tenderness (most patients do not want to be touched in the abdomen); * a tender, sausage-shaped mass near the umbilicus (present in 50 to 70% of patients); * decreased or absent bowel sounds; * nausea; * vomiting; and * increased pulse rate (tachycardia[prep4usmle.com]
  • Clinical evaluation the patient’s physical examination was remarkable for tachycardia to 108, an oxygen saturation of 94% on 2 liters oxygen supplementation via nasal cannula, clear lungs, and abdomen that was minimally tender to palpation in the deep[panafrican-med-journal.com]
Vascular Disease
  • You are more likely to have vascular disease as you get older.[icdlist.com]
  • Vascular Disease Foundation [On-line information]. PDF available for download at . Accessed August 2010. Lehman, C. et. al. (Updated 2010 January). Disseminated Intravascular Coagulation – DIC. ARUP Consult [On-line information].[labtestsonline.it]
Pelvic Pain
  • The pelvic pain may be intermittent or constant, often with changing degrees of discomfort.[tennesseeveincare.com]
  • Approximately one third of all women will suffer from chronic pelvic pain at some point during their lifetime. Chronic pain by definition lasts longer than six months and is not related to a woman’s menstrual cycle.[vein.stonybrookmedicine.edu]
  • This increased flow in the legs causes an increase in the pelvic veins which dilate to accommodate around the obstruction causing pelvic pain. This may be intermittent or constant.[varicosevascular.com]
  • Isolated ovarian vein thrombosis is an important, although rare, etiology of abdominal and pelvic pain.[jaocr.org]
  • A presentation is usually with acute pelvic pain in the postpartum period, then termed puerperal ovarian vein thrombosis or postpartum ovarian vein thrombosis .[radiopaedia.org]
Flank Pain
  • Two of those cases were discovered incidentally. 3 Presentation OVT most commonly presents with an acute onset of abdominal or flank pain.[acepnow.com]
  • Her postpartum course was uneventful until the fourth day, when she complained of fever and right-flank pain with nausea and vomiting. Clinical examination revealed a temperature of 39 C and right lower quadrant tenderness, no masses were detected.[najms.org]

Workup

  • Many patients are asymptomatic and others may be diagnosed incidentally during coelioscopy or in etiology workup of pulmonary embolism [6], [12].[najms.org]

Treatment

  • Treatment of pelvic vein thrombophlebitis requires administration of broad spectrum antibiotics, intravenous heparin, and, in selected cases, ovarian vein and vena cava ligation.[ncbi.nlm.nih.gov]
  • Once other conditions are ruled out, the ultimate diagnosis of septic pelvic vein thrombophlebitis may depend on how you respond to treatment. In the past, treatment would involve tying or cutting out the vein. This is no longer the case.[healthline.com]
  • Treatment of pelvic vein thrombophlebitis requires administration of broad spectrum antibiotics, intravenous heparin, and, in selected cases, ovarian vein and vena cava ligation. Williams & Wilkins 1983. All Rights Reserved.[journals.lww.com]
  • For treatment , you might take anticoagulants for at least 3 months.[northshore.org]
  • […] and prognosis Appropriate treatment consists of a combination of anticoagulation and antibiotics.[radiopaedia.org]

Prognosis

  • […] the ovarian vein may not be identified in every case 14 . tubular/serpiginous hypoechoic structure in the adnexa adjacent to the ovarian artery if the ovarian vein is identifiable, the absence of Doppler flow can be a diagnostic feature Treatment and prognosis[radiopaedia.org]
  • What are the symptoms, treatment, and prognosis for phlebitis? Pain, swelling, redness, and tenderness are some common symptoms of phlebitis.[medicinenet.com]
  • Phlebitis Prognosis Superficial phlebitis is rarely serious and usually responds to pain control, elevation, and warm compresses.[emedicinehealth.com]

Etiology

  • Clearly, the emergency physician will be on the lookout for the more common etiologies mentioned above. In this case, the emergency physician was appropriately suspicious for acute appendicitis.[acepnow.com]
  • Isolated ovarian vein thrombosis is an important, although rare, etiology of abdominal and pelvic pain.[jaocr.org]
  • This has been attributed to the dextrorotation of the uterus during pregnancy compressing that vein, but also to the increased length of the right ovarian vein and the presence of incompetent valves. [1] The etiology is thought to be due to Virchow’s[ijcasereportsandimages.com]
  • Ovarian vein thrombosis: analysis of patient age, etiology, and side of involvement. Del Med J 2013; 85(2): 45–50. Basili G, Romano N, Bimbi M, Lorenzetti L, Pietrasanta D, Goletti O. Postpartum ovarian vein thrombosis. JSLS 2011; 15(2): 268–71.[vestnik.szd.si]
  • Many patients are asymptomatic and others may be diagnosed incidentally during coelioscopy or in etiology workup of pulmonary embolism [6], [12].[najms.org]

Pathophysiology

  • The pathophysiology of POVT is related to the Virchow triad: the veinous stasis and hypercoagulability that commonly accompany the puerperium with superimposed injury to the vein wall usually caused by uterine infection [3], [6].[najms.org]

Prevention

  • Take antibiotics as a preventive measure before and after any surgeries, including a cesarean delivery. Make sure to stretch your legs and move around after your cesarean delivery.[healthline.com]
  • How can deep vein thrombosis be prevented? There are things you can do to prevent DVT. After surgery, you can take an anticoagulant medicine to prevent blood clots. You might also wear compression stockings.[northshore.org]
  • The good news is that DVT is preventable and treatable if discovered early.[cdc.gov]
  • How can you prevent phlebitis? Simple measures can be taken to prevent phlebitis, although, sometimes it cannot be avoided.[medicinenet.com]
  • The goal of anticoagulation therapy is to find a middle ground where you continue to clot when your body needs to clot, yet at the same time prevents your thrombosis or embolism from getting worse.[ucsfhealth.org]

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