Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
Hamostaseologie. 2021 Aug;41(4):257-266. doi: 10.1055/a-1306-4327. Epub 2020 Dec 21.
Ovarian vein thrombosis (OVT) is a rare type of venous thromboembolism. The most common risk factors for OVT include pregnancy, oral contraceptives, malignancies, recent surgery, and pelvic infections; however, in 4 to 16% of cases, it can be classified as idiopathic. Most of the available information regards pregnancy-related OVT, which has been reported to complicate 0.01 to 0.18% of pregnancies and to peak around 2 to 6 days after delivery or miscarriage/abortion. The right ovarian vein is more frequently involved (70-80% of cases). Clinical features of OVT include abdominal pain and tenderness, fever, and gastrointestinal symptoms. The most typical finding is the presence of a palpable abdominal mass, although reported in only 46% of cases. OVT can be the cause of puerperal fever in approximately a third of women. Ultrasound Doppler is the first-line imaging, because of its safety, low cost, and wide availability. However, the ovarian veins are difficult to visualize in the presence of bowel meteorism or obesity. Thus, computed tomography or magnetic resonance imaging is often required to confirm the presence and extension of the thrombosis. In oncological patients, OVT is often an incidental finding at abdominal imaging. Mortality related to OVT is nowadays low due to the combination treatment of parenteral broad-spectrum antibiotics (until at least 48 hours after fever resolution) and anticoagulation (low-molecular-weight heparin, vitamin K antagonists, or direct oral anticoagulants). Anticoagulant treatment duration of 3 to 6 months has been recommended for postpartum OVT, while no anticoagulation has been suggested for incidentally detected cancer-associated OVT.
卵巢静脉血栓形成（OVT）是一种罕见的静脉血栓栓塞症。OVT 的最常见危险因素包括妊娠、口服避孕药、恶性肿瘤、近期手术和盆腔感染；然而，在 4%至 16%的病例中，它可以被归类为特发性。大多数现有信息涉及与妊娠相关的 OVT，据报道，妊娠相关 OVT 占妊娠的 0.01%至 0.18%，并在分娩后 2 至 6 天或流产/堕胎时达到高峰。右侧卵巢静脉更常受累（70-80%的病例）。OVT 的临床特征包括腹痛和压痛、发热和胃肠道症状。最典型的表现是可触及的腹部肿块，尽管仅在 46%的病例中报告。OVT 约可引起三分之一的产褥热妇女的发热。由于其安全性、低成本和广泛可用性，超声多普勒是一线成像方法。然而，在存在肠气胀或肥胖的情况下，卵巢静脉难以可视化。因此，通常需要计算机断层扫描或磁共振成像来确认血栓的存在和延伸。在肿瘤患者中，OVT 通常是腹部成像的偶然发现。由于采用静脉注射广谱抗生素（直至发热消退后至少 48 小时）和抗凝治疗（低分子肝素、维生素 K 拮抗剂或直接口服抗凝剂），OVT 的死亡率现已降低。对于产后 OVT，推荐抗凝治疗 3 至 6 个月，而对于偶然发现的与癌症相关的 OVT 则不建议抗凝治疗。
