key: cord-1022159-uzfenrr6 authors: Badrawi, Noor; Abdulghaffar, Shareefa title: Ovarian vein thrombosis as a first manifestation of COVID-19 infection date: 2021-08-16 journal: Radiol Case Rep DOI: 10.1016/j.radcr.2021.08.024 sha: d3c36542ce26139b97f2b0e4d28a72fb51df613f doc_id: 1022159 cord_uid: uzfenrr6 COVID-19 infection is associated with high risk of venous thromboembolic events mainly pulmonary embolism or deep venous thrombosis of the lower limbs. Ovarian vein thrombosis is a rare and serious condition usually seen in the immediate postpartum period and other conditions including pelvic inflammatory diseases, gynecological malignancies, hypercoaguable states and few cases to date have reported ovarian vein thrombosis as a complication of COVID-19 infection. Patient with ovarian vein thrombosis usually presents with fever and lower abdominal pain that can mimic acute surgical abdomen and high index of suspicion is required for diagnosis. We report a case of a 41-year-old Asian female presented to our hospital with fever and acute lower abdominal pain. Laboratory findings shows positive COVID-19 test and high D-dimer. Patient underwent computed tomography (CT) of the abdomen and pelvis and a confirmed diagnosis of right ovarian vein thrombosis was made. Patient was treated with anticoagulation and empirical antibiotics and her symptoms has significantly improved. vein thrombosis was made. Patient was treated with anticoagulation and empirical antibiotics and her symptoms has significantly improved. Ovarian vein thrombosis, Novel Corona Virus, Covid-19, SARS-CoV-2, Computed Tomography A 41-year-old Asian female with no significant past medical or surgical history , presented to the accident and emergency department with one day duration history of right lower abdominal pain associated with vomiting. She described the pain as colicky in nature, progressively increasing in intensity and not relieved by pain killers. She also gave history of dysuria, vaginal discharge and one day history of fever and chills. She denied history of constipation or diarrhea, loss of appetite or weight loss, cough, or shortness of breath. The patient has regular menstrual cycles and had two Ovarian vein thrombosis (OVT) commonly present with right iliac fossa pain (55%) and fever (80%). Risk factors for developing OVT includes postpartum period, patients with pelvic inflammatory disease, malignancies, or previous abdominal/pelvic surgeries. 4 It may mimic acute surgical abdomen particularly acute appendicitis, ovarian torsion, pelvic inflammatory disease, or tubo-ovarian abscess. 5 Therefore, high index of suspicion and prompt diagnosis through imaging with contrast enhanced CT scan of the abdomen is required. Right ovarian vein thrombus is seen in 70-90% of cases. 6 Ovarian vein thrombosis is a rare condition presenting with lower quadrant pain and may mimic other conditions. CT scan with intravenous contrast is the most useful imaging modality for diagnosis. While COVID19 related coagulopathy usually comes in the form of DVT in the lower limbs or PE in the lungs, other veins may also be thrombosed and present acutely as presented in this case. A written consent was obtained from the patient for publication of this case and any accompanying images. No financial disclosure. Coronavirus disease (COVID-19 Pandemic) Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study Prevention and treatment of venous thromboembolism associated with coronavirus disease 2019 infection: a consensus statement before guidelines Acute appendicitislike symptoms as initial presentation of ovarian vein thrombosis Ovarian vein thrombosis in the nonpregnant woman: an overlooked diagnosis Postpartum ovarian vein thrombosis: an unpredictable event: two case reports and review of the literature Left gonadal vein thrombosis in a patient with COVID-19-associated coagulopathy