Idiopathic Bilateral Ovarian Vein Thrombosis in a Non-Pregnant Healthy Patient: A Case Report and Review of the Literature

Abstract

Ovarian vein thrombosis (OVT) is a potentially life-threatening condition, and it is typically related to the peripartum period; however, it is also associated with pelvic inflammatory disease, recent pelvic or abdominal surgery, inflammatory bowel disease, thrombophilia, malignancy, and sepsis. Idiopathic isolated OVT is rare and is usually presented as case reports in the medical literature. In this report, we present a case of bilateral OVT in a postmenopausal female with no identifiable risk factors and normal coagulation profile workup to highlight the importance of considering it as a differential diagnosis in female patients presenting with abdominal pain. Early identification can prevent potentially life-threatening complications. Management is often conservative, and the choice of anticoagulation is based on the patient's medical conditions. In this particular scenario, the patient was managed with low molecular weight heparin (LMWH) and transitioned to direct oral anticoagulant (DOAC) before discharge.

Bilateral ovarian vein thrombosis without underlying conditions: A case report

“…Currently, data are lacking on whether anticoagulants should be administered to patients with mild symptoms but no underlying conditions, such as the present patient. As previously described, two symptomatic cases were reported with idiopathic bilateral OVTs, where anticoagulation worked effectively with oral anticoagulants and low molecular‐weight heparin followed by oral anticoagulants, respectively 3,5 . In the present patient, the thrombus in the right ovarian vein nearly reached to IVC, which prompted us to use anticoagulants to reduce the risk of PE.…”

“…However, the treatment protocols/strategies are not standardized, that is., oral vs. intravenous, how long, and how to monitor. Contrarily, some data suggest that anticoagulation does not affect thrombosis progression or PE occurrence in cases of incidentally detected OVT 3 . Currently, data are lacking on whether anticoagulants should be administered to patients with mild symptoms but no underlying conditions, such as the present patient.…”

“…Bilateral OVTs without underlying conditions (idiopathic bilateral OVTs) are very rare. To our knowledge, there have been only two such cases hitherto reported with abdominal pain 3,5 …”

“…A literature review in 2017 retrieved only 10 cases of OVT without underlying conditions (idiopathic OVT) 2 . In addition, it usually occurs unilaterally, with a right‐sided dominance 2,3 . It is controversial to use anticoagulants to ameliorate the condition and prevent pulmonary embolism (PE), with the latter being reported to occur in 13%–25% of OVT cases 1 .…”

A Rare Case of Idiopathic Gonadal Vein Thrombosis

“…Basit et al reported a case of idiopathic bilateral OVT. Their literature review identified 12 cases of idiopathic unilateral OVT, most of which had risk factors for OVT [15].…”