Idiopathic bilateral ovarian vein thrombosis

Ovarian vein thrombosis (OVT) is a condition most commonly associated with malignancy, hypercoagulable disorders, pelvic surgery, trauma, inflammatory bowel disease and the postpartum period. Idiopathic bilateral OVT is extremely rare. We report the case of a 30-year-old African-American woman who presented with bilateral lower pelvic pain and nausea. She had no recent pelvic infections nor a personal or family history of malignancy or thrombophilia. Workup results for a hypercoagulable state was negative. A CT scan of the abdomen and pelvis revealed bilateral OVT. Treatment included novel oral anticoagulants or warfarin, with comparison studies showing a similar risk-benefit ratio. Repeat imaging is recommended after 40-60 days to determine the necessity for further anticoagulation. Emphasis is placed on starting anticoagulation early in order to reduce the risk of extension of the thrombus into the inferior vena cava, conversion to pulmonary embolism or increase in the risk of infection.