Left Ovarian Vein Thrombosis Presenting as Acute Postpartum Pyelonephritis

Ovarian Vein Thrombosis (OVT) is an extremely rare and uncommon thrombotic condition commonly attributed to the postpartum period. We report a case of a 30 yr old P2002 who presented with one day history of fever, chills, vomiting, abdominal and left flank pain. Patient had a preterm vaginal birth at 34 weeks gestation, four days prior to her presentation. Patient was febrile on presentation with left CVA tenderness and diffuse abdominal tenderness. Pelvic Ultrasound showed enlarged uterus 14.7cm x 10.9cm x 8.5cm consistent with a postpartum uterus, with heterogeneous endometrium 2.3 cm, no retained products and normal adnexa. CT scan with contrast showed fluid along the anterior aspect of the left anterior kidney, left psoas muscle and extending down to the left side of the uterus and extending to the region of the left renal vein which confirmed left ovarian thrombosis. A CT Chest with contrast and bilateral lower extremity Doppler ruled out pulmonary embolism and deep vein thrombosis, respectively. The patient was admitted, treated with antibiotics and therapeutic dose of low molecular weight heparin (Enoxaparin) and responded well. Patient was discharged home on oral apixaban. The clinical presentation of OVT is non-specific and can be similar to that of acute pyelonephritis. Physicians should have a high index of suspicion in postpartum patients presenting with flank pain and imaging techniques such as MRI, CT scan and ultrasound should be used to help in making the diagnosis.