Role of duplex color Doppler ultrasound, computed tomography, and MR angiography in the diagnosis of septic puerperal ovarian vein thrombosis

Background: Septic puerperal ovarian vein thrombosis (SPOVT) is one of the underlying etiologies of puerperal fever. A correct diagnosis of this condi tion is important because adequate treatment requires additional administra tion of anticoagulants. The purpose of this study was to evaluate the role of duplex color Doppler ultrasound (CDUS), computed tomography (CT), and ma gnetic resonance angiography (MRA) in the detection of SPOVT. Methods: Twenty-six patients with puerperal fever suspected to be due to SP OVT and unresponsive to broad antibiotic treatment for at least 48 h were i ncluded in a prospective study using CDUS, CT, and MR imaging including MRA . Examinations were analyzed and then correlated to a standard of reference gathered from surgical and clinical follow-up data and from results of ima ging. Results: SPOVT was present in nine patients (right side 8, bilateral n = I) . CDUS was inconclusive due to gaseous distention of the bowel or obesity i n 13 of 26 cases. After counting inconclusive findings as wrong results for statistical purposes, sensitivity, specificity, and accuracy for CDUS were 55.6%, 41.2%, and 46.2%, respectively. CT had a sensitivity of 77.8% with a specificity of 62.5%; accuracy was 68.0%. MRA rendered conclusive results in all evaluated patients, resulting in a sensitivity and specificity of 1 00%. Conclusion: MRA is recommended in all patients with inconclusive CDUS findi ngs and persistent suspicion for SPOVT. CT has the advantage of more rapid access and lower cost and thus will probably remain a sufficiently accurate alternative.