Left Ovarian Vein Thrombosis Mimicking Pyelonephritis: A Case Report

Abstract Introduction Ovarian vein thrombosis (OVT) is an uncommon condition, most frequently occur in the postpartum period. The presentation includes pelvic pain, fever, and abdominal mass. Although a rare diagnosis, OVT can potentially cause fatal complications; thus, early recognition and prompt treatment are important. Case presentation We present a case of a 29-year-old lady, Para 2, previously healthy, who presented 10 days after vaginal delivery with left-sided flank pain, fever, and burning micturition. The patient had a vaginal delivery at term complicated by extended episiotomy, which was sutured in operative theatre. Laboratory tests revealed elevated white blood cell (WBC) count (12000 cells/mm3) with neutrophilia and (20-25 WBC in high power field) in urine examination. The initial differential diagnosis was cystitis or pyelonephritis. Abdominal ultrasound showed an enlarged left kidney, no stones or hydronephrosis. Abdominal and pelvic contrast-enhanced computed tomography (CT) scan showed left OVT extending to the left renal vein and inferior vena cava. Urine culture was positive for Escherichia coli. Thus, she was started on anticoagulants, and antibiotics and discharged home after improvement. Follow-up revealed the resolution of the clot. Conclusion OVT is a rare condition, usually in the postpartum period. Its presentation can mimic other differential diagnoses, so a high index of suspicion is required for prompt diagnosis and management. Diagnosis can be obtained using a CT scan, magnetic resonance, or ultrasound (US) Doppler. Treatment includes a combination of anticoagulants and antibiotics. The prognosis is good nowadays.