Five days after an emergency cesarean section, a woman remains febrile at 39 degrees Celsius despite broad-spectrum antibiotics. She has right-sided flank pain, a tender ropelike mass extending toward the right costal margin, and rising neutrophil count. Contrast CT shows a dilated, thrombosed vessel. The most likely diagnosis is:

• A Pelvic abscess in the pouch of Douglas
• B Acute appendicitis
• C Right ovarian vein thrombosis ✓
• D Retroperitoneal hematoma

Explanation

Postpartum ovarian vein thrombosis classically presents days 2 to 8 after cesarean delivery with fever unresponsive to antibiotics, unilateral flank pain and a tender palpable abdominal mass, right-sided in 70 to 90 percent of cases due to slower venous flow after dextrorotation of the gravid uterus. CT confirms the diagnosis. Treatment is therapeutic anticoagulation with heparin. An abscess or hematoma produces a collection, not a dilated tubular vascular structure.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.