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Floating caval thrombus arising from the ovarian vein
Andreas Kuehnl1, Afshin Assadian, Christian Reeps
1Clinic for Vascular Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Annals of Vascular Surgery
|September 15, 2009
Summary
A pregnant woman developed ovarian vein thrombosis after C-section, progressing to a dangerous caval thrombus. Prompt surgical thrombectomy successfully removed the clot, leading to rapid recovery.
Area of Science:
- Vascular Surgery
- Obstetrics and Gynecology
- Thrombosis Management
Background:
- Postpartum complications can include thromboembolic events.
- Ovarian vein thrombosis (OVT) is a rare but serious condition, particularly in the postpartum period.
- Chorioamnionitis is an infection of the amniotic fluid and membranes, increasing risk for postpartum complications.
Observation:
- A 37-year-old postpartum patient presented with fever and abdominal pain following an emergency Cesarean section for suspected chorioamnionitis.
- Initial computed tomography revealed right ovarian vein thrombosis.
- Despite anticoagulation, color duplex imaging showed a free-floating inferior vena cava (IVC) thrombus extending to the hepatic vein confluence.
Findings:
- The patient developed a significant caval thrombus despite therapeutic anticoagulation.
- Emergency surgical thrombectomy via laparotomy was required for thrombus removal.
- The procedure involved suprahepatic clamping of the inferior vena cava.
Implications:
- This case highlights the potential for rapid progression of postpartum OVT to extensive caval thrombus.
- Aggressive surgical intervention may be necessary for free-floating caval thrombi in anticoagulated patients.
- Early recognition and management are crucial for favorable outcomes in severe postpartum venous thromboembolism.
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