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CT Abd Gonadal Vein Thrombosis

Technique: IV contrast enhanced helical CT of the abdomen and pelvis was performed from the lower thoracic margin through the symphysis pubis. Coronal and sagittal reformats were provided.

Findings: Bilateral pleural effusions are noted, right greater than left. There is a calcific density demonstrated within the right lower lobe, likely representing old granulomatous disease. The base of the heart is unremarkable in appearance.

Periportal hypoattenuation is demonstrated. Dependent fluid is noted within the cul-de-sac and within the right paracolic gutter. Two left external iliac stents are noted to the junction of the inferior vena cava. Mixing artifact is seen in the suprarenal inferior vena cava, but it appears to resolve on the renal delay images. Surgical clips are noted in the right upper quadrant. Bilateral tubal occlusion clips are noted. There is questionable thrombus in the left gonadal vein (Series 601 Image 51) . There is a single 6 x 6 x 7 mm low attenuating focus demonstrated within the lower uterine segment, which may represent a fibroid (series 3 image 60).

The spleen, kidneys, adrenal glands, and pancreas are normal in appearance. There is no lymphadenopathy or evidence of free intraperitoneal air. The common bile duct measures 6 mm in greatest dimension, though this is expected in the post cholecystectomy setting. Evaluated osseous structures are unremarkable in appearance.

Mixed luminal filling defects in native IVC with enlarged right partially opacified gonadal vein suggests re- thrombosis or chronic thrombosis of the venous system. This finding may be re-evaluated with venous phase CT scan of the abdomen and pelvis.

Other findings as previously reported:

1. Periportal edema is nonspecific, but may be seen with aggressive IV hydration, hepatic congestion, hepatitis, or other hepatic inflammatory conditions.
2. Intraperitoneal fluid as above is likely physiologic or related to the rupture of known hemorrhagic ovarian cysts, which the patient is known to have. Retroperitoneal bleeding is considered less likely given the lack of focal hematoma. Correlate for signs of peritonitis and trend AGB/CCT and consider re- imaging if clinically appropriate.
3. Left external iliac overlapping stents that do not appear to be thrombosed.
4. Questionable thrombosis of the left gonadal vein.
5. Bilateral pleural effusions, right greater than left.
6. Postoperative changes and indwelling hardware as above.