Case notes
A 30-year-old woman, gravida 3 para 3, presented to the emergency department after 9 days of left lower-quadrant abdominal pain. Fourteen days earlier, she had undergone surgical repair of a congenital left ureteropelvic defect. Specifically, the patient, who had a left ureteral stent in place for prior unilateral hydronephrosis, underwent a repeat laparoscopic ureteropyeloplasty with the use of intraoperative and postoperative pneumatic calf compression boots. After the procedure, she developed dull left lower-quadrant abdominal pain and a fever of 101.4°F (38.5°C).
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Ciprofloxacin was prescribed for a suspected urinary tract infection. The fever resolved, but the patient continued to experience left lower abdominal pain, prompting her visit to the hospital.
She had no history of tobacco or hormonal contraceptive use and no personal or family history of hypercoagulation. A physical examination was notable for a woman of normal body mass index with tenderness to palpation in the left lower quadrant. A palpable mass along the lateral wall of the vagina was noted on internal examination.
Transvaginal ultrasound demonstrated a 33 × 14 × 10 mm solid avascular structure located medial to the left ovary; this was initially thought to represent a pyosalpinx ( Figure 1 ). Subsequent computed tomography (CT) of the abdomen and pelvis, accomplished with intravenous contrast material, showed a large thrombus within a dilated left ovarian vein. The clot extended from the pelvis into the left renal vein ( Figure 2 ).
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