Anales de la RANM

181 A N A L E S R A N M R E V I S T A F U N D A D A E N 1 8 7 9 AN UNUSUAL CASE OF ACUTE ABDOMEN Anca Oprisan, et al. An RANM. 2021;138(02): 180 - 182 both ovarian veins (Fig.1a-1b) from the uterus up to the renal vein on the left (Fig. 2a) and to the inferior vena cava to the right (Fig. 2b). There is associ- ated thickening and enhancement of the walls of the ovarian and uterine veins. No free fluid, collections or lymphadenopathy were observed. Ovarian vein thrombophlebitis is a difficult diagnosis, so there must be a high clinical suspicion and the final diagnosis will be reached through imaging studies. Usually, ultrasonography with Doppler examination is the first technique performed since is less expensive and requires no contrast material (3). Contrast- enhanced CT and MRI have the highest sensitivity and specificity to diagnose the ovarian veins thrombi (4). Normally, the CT examination shows a tubular retroperitoneal mass with a central low attenuation extending from the ovaries to the renal vein on the left or to the inferior vena cava on the right. The differential diagnosis is made mainly with appendicitis, tubo-ovarian abscess and renal colic. CT is highly sensitive for these diseases. In appendi- citis we can identify a structure that arise from the cecum inferior to the ileo-cecal junction and on CT it can be associated with fat stranding near the vermiform structure and also with hyperdense foci within the lumen. Tubo-ovarian abscess is the late complications of pelvic inflammatory disease and on CT we can find a tubular configuration fluid attenua- tion pelvic masses which may show a thick enhancing wall and may contain fluid-fluid levels or gas. Renal colic is a pattern of abdominal pain most commonly caused by ureteric calculi. The pain is felt in the loin radiating down to the groin because of the peristalsis or spasm of the ureter. The calculi it can be easily identified on CT. Figure 1a. Axial contrast- enhanced CT image shows the presence of hypodense material occupying and dis- tending left ovarian vein (arrow) with thickening and enhancement of the walls. Figure 1b. Axial contrast- enhanced CT image shows the presence of hypodense material occupying and dis- tending right ovarian vein (arrow) with thickening and enhancement of the walls. DISCUSSION