Postpartum ovarian vein thrombosis causing severe hydronephrosis

Ovarian vein thrombosis is a rare postpartum complication. The diagnosis is often delayed, given that the differential diagnosis is broad. This case illustrates an unusual presentation of postpartum ovarian vein thrombosis.

A young woman presented on postpartum day 3 after an uncomplicated vaginal delivery with severe right lower quadrant abdominal pain and right thigh numbness. A computed tomographic scan demonstrated severe right hydronephrosis and right pyelocalyceal rupture and was suggestive of a right ovarian vein thrombosis. She was admitted and treated with a right nephrostomy tube and anticoagulation. Four weeks after nephrostomy tube placement, she underwent right antegrade nephrostography, and free flow of contrast from her distal ureter to her bladder was seen without evidence of obstruction.

Ovarian vein thrombosis should be considered in the differential diagnosis of any woman in the puerperium presenting with pelvic or abdominal pain.