Five days after an emergency caesarean section, a woman has spiking fevers unresponsive to broad-spectrum antibiotics. She has right-sided flank and loin pain, and a tender, pulsatile mass is felt in the right iliac fossa. Contrast-enhanced CT confirms the diagnosis. What is the most likely diagnosis?

• A Right ovarian vein thrombosis ✓
• B Wound dehiscence with haematoma
• C Appendicular abscess
• D Pelvic abscess in the pouch of Douglas

Explanation

Ovarian vein thrombosis typically presents 2 to 5 days postpartum, more often on the right, with persistent fever refractory to antibiotics, flank pain, and a tender ropelike mass along the course of the ovarian vein. It follows endometritis and arises from venous stasis and hypercoagulability. CT with contrast is diagnostic, showing a dilated, non-enhancing vein. Treatment is anticoagulation with heparin plus continued antibiotics.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.