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]
Entire Body System
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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]
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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]
Gastrointestinal
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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]
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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]
Cardiovascular
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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]
Although tachycardia is common with fever and a pulse of greater than 90 beats/min qualifies as one of the criteria for sepsis. [glowm.com]
Fetal tachycardia (170 bpm) with a non-reactive pattern was detected. A fetal Doppler sonography revealed a 'brain-sparing' effect with a cerebroplacental ratio of 0.75 (normal 1) [ 1 ]. An urgent cesarean delivery was performed. [jmedicalcasereports.biomedcentral.com]
Urogenital
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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]
Workup
Many patients are asymptomatic and others may be diagnosed incidentally during coelioscopy or in etiology workup of pulmonary embolism [6], [12]. [najms.org]
The diagnostic workup of a patient with suspected TSS starts with a complete physical examination to investigate signs of multiorgan involvement. A pelvic examination is performed, which includes the removal of a tampon if one is present. [glowm.com]
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 the treatment of VTE, rivaroxaban is given orally at 15 mg twice a day for the initial 21 days of treatment, followed by once daily at 20 mg per day for long-term treatment. [clevelandclinicmeded.com]
For treatment, you might take anticoagulants for at least 3 months. [northshore.org]
Prognosis
Abstract Background: Thrombotic events are common in cancer patients and have been associated with an adverse prognosis in large registry-based studies. [nature.com]
[…] 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]
Thrombosis of the iliofemoral veins carries a worse prognosis with increased incidence of late clinical complications such as post-thrombotic syndrome [ 15 ]. [patient.info]
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]
Epidemiology
Epidemiology DVT has an annual incidence of about 1 in 1,000 people [ 3 ]. [patient.info]
Pathophysiology
The pathophysiology of SPT is outlined by Virchow's triad: Venous stasis Injury to the vascular epithelium A hypercoagulable state These factors explain why SPT is almost always a puerperal event that is most commonly diagnosed after postcesarean endomyometritis [glowm.com]
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]