The inferior vena cava (IVC) is the main conduit of venous return to the right atrium from the lower extremities and abdominal organs. Agenesis of the IVC has an incidence of <1% in the general population [1], although it has been reported in the literature as occurring in up to 8.7% of the population [2]. Patients with absent IVC may present with symptoms of lower extremity venous insufficiency [6], idiopathic deep venous thrombosis [7], or pelvic congestion syndrome. To our knowledge there have only been a few cases reported in the literature of agenesis of the IVC associated with pelvic congestion syndrome [3,10,11]. We present another interesting case of pelvic congestion syndrome due to absent IVC.
Patients who get pregnant after being treated with in vitro fertilization (IVF) are at significantly increased risk of ovarian torsion compared to the general population and also in comparison to patients who get pregnant normally [1,2]. The risk is further increased in patients who develop ovarian hyperstimulation syndrome [1]. This possibility should be considered in this group of patients presenting with acute abdominal pain and immediate management should be commenced. Here, we report 2 patients who received treatment for infertility with IVF and developed ovarian torsion and we discuss their management including the imaging workup. The first case is a 34-year-old woman at 11 + 3 weeks of gestation after IVF who presented with a 12-hour acute right lower abdominal pain with nausea and vomiting. She underwent an ultrasound examination and then further evaluated with magnetic resonance imaging which showed asymmetric enlargement of the right ovary and stromal edema and a diagnosis of ovarian torsion was made. The patient underwent laparoscopic detortion and the ovary was salvaged. The second case is a 33-year-old woman at 9 weeks of gestation after IVF who presented with intermittent abdominal pain, vaginal bleeding, and nausea and vomiting for 5 days but became worse on the fifth day. Ultrasound and subsequently magnetic resonance imaging were performed which confirmed hyperstimulation syndrome. Abnormal location of the left ovary anterior to the uterus with higher volume as well as the clinical progression raised the possibility of ovarian torsion and prompted a diagnostic laparoscopy which showed right ovarian torsion and detortion was performed.
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