A 27-year-old woman develops a spiking fever and right-sided abdominal pain on the fourth day after an emergency cesarean section for prolonged labor. She is tachycardic. Examination reveals a tender, firm, ropelike mass in the right flank lateral to the uterus. CT shows a dilated, thrombosed right ovarian vein extending toward the inferior vena cava. Blood cultures are negative. What is the most appropriate initial management?

• A Broad-spectrum antibiotics combined with therapeutic anticoagulation using heparin ✓
• B Broad-spectrum antibiotics alone, with serial imaging to confirm resolution
• C Immediate surgical exploration with excision of the thrombosed vein
• D Aspirin 150 mg daily with follow-up imaging in six weeks

Explanation

Ovarian vein thrombosis typically presents on days 2 to 5 postpartum with fever, flank pain, and a tender palpable mass, more often on the right because the right ovarian vein is longer and drains directly into the vena cava. Management combines broad-spectrum antibiotics covering anaerobes with therapeutic anticoagulation, usually low molecular weight heparin, continued for several months. Antibiotics alone are inadequate because the thrombus can propagate to the renal vein or vena cava. Surgery is reserved for failure of medical therapy or free-floating thrombus extension.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.