Indian Journal of Nuclear Medicine
Home | About IJNM | Search | Current Issue | Past Issues | Instructions | Ahead of Print | Online submissionLogin 
Indian Journal of Nuclear Medicine
  Editorial Board | Subscribe | Advertise | Contact
Users Online: 417 Print this page  Email this page Small font size Default font size Increase font size


 
 Table of Contents     
INTERESTING IMAGES
Year : 2016  |  Volume : 31  |  Issue : 4  |  Page : 305-306  

Rare case of an ovarian vein tumor thrombosis identified on fluorodeoxyglucose positron emission tomography/computed tomography


Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India

Date of Web Publication19-Sep-2016

Correspondence Address:
Venkatesh Rangarajan
Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, E. Borges Road, Parel, Mumbai - 400 012, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.190795

Rights and Permissions
   Abstract 


Fludeoxyglucose positron emission tomography/computed tomography is valuable in the identification of tumor thrombus and differentiating it from bland thrombus which has implications in initiating anticoagulation. We present a rare case of tumor thrombosis in ovarian vein, in a recurrent case of uterine carcinosarcoma.

Keywords: Anticoagulation, carcinosarcoma, fludeoxyglucose positron emission tomography/computed tomography, ovarian vein, tumor thrombosis, uterine


How to cite this article:
Chandra P, Agrawal A, Purandare N, Shah S, Rangarajan V. Rare case of an ovarian vein tumor thrombosis identified on fluorodeoxyglucose positron emission tomography/computed tomography. Indian J Nucl Med 2016;31:305-6

How to cite this URL:
Chandra P, Agrawal A, Purandare N, Shah S, Rangarajan V. Rare case of an ovarian vein tumor thrombosis identified on fluorodeoxyglucose positron emission tomography/computed tomography. Indian J Nucl Med [serial online] 2016 [cited 2019 May 21];31:305-6. Available from: http://www.ijnm.in/text.asp?2016/31/4/305/190795



A 50-year-old female, an operated case of carcinosarcoma uterus (3 months ago), presenting with increased abdominal pain, underwent positron emission tomography/computed tomography (PET/CT) for evaluation of suspicious disease recurrence. Maximum intensity projection images [Figure 1]a showed intense fludeoxyglucose (FDG) uptake in the pelvis with linear intense FDG uptake extending from the right pelvis up to the renal hilum and another linear, intense FDG uptake in the mid abdomen medial to it. Coronal FDG PET fused PET/CT [Figure 1]b image in the pelvis showed FDG avid recurrent disease in the right side of pelvis and tumor thrombus in bilateral internal iliac veins (white arrows). Coronal fused FDG-PET/CT [Figure 2]a and contrast enhanced CT [Figure 2]b of the abdomen showed linear FDG uptake in the enlarged right ovarian vein (bold white arrow) and physiological uptake in the left ureter medial to it (thin white arrow). Sagittal fused FDG PET/CT [Figure 2]c image of abdomen showed anterior relation of the ovarian vein tumor thrombus to the psoas muscle posteriorly. Transaxial fused PET/CT [Figure 2]d images show the proximal opening of the ovarian vein with tumor thrombus into the inferior vena cava (white arrowhead). Additional FDG avid metastatic lesions were noted in the enlarged pelvic nodes, sacrum, and upper lobe of the right lung (not shown above).
Figure 1: Maximum intensity projection image (a) showed intense FDG uptake in the pelvis with linear intense FDG uptake extending from the right pelvis up to the renal hilum and another linear intense FDG uptake in the mid abdomen medial to it. Coronal FDG PET fused PET/CT (b) image in the pelvis showed FDG avid recurrent disease in the right side of pelvis and tumor thrombus in bilateral internal iliac veins (white arrows). FDG: Fludeoxyglucose; PET: Positron emission tomography; CT: Computed tomography

Click here to view
Figure 2: Coronal fused FDG PET/CT (a) and contrast enhanced CT (b) of the abdomen showed linear FDG uptake in the enlarged right ovarian vein (bold white arrow) and physiological uptake in the enlarged left ureter medial to it (thin white arrow). Sagittal FDG PET/CT (c) image of abdomen showed the anterior relation of the ovarian vein tumor thrombus to the psoas muscle posteriorly. Transaxial FDG PET/CT (d) images show the proximal opening of the ovarian vein with tumor thrombus into the inferior vena cava (white arrowhead). FDG: Fludeoxyglucose; PET: Positron emission tomography; CT: Computed tomography

Click here to view


Ovarian vein thrombosis (OVT) is a rare condition, usually seen in postpartum period and predisposes patient at risk for fatal pulmonary thromboembolism.[1],[2] Other causes are debulking pelvic surgeries, pelvic inflammatory diseases, and malignancies.[3],[4] The recognition of this entity is important as it has been seen that survival is better in OVT in patients with cancer, compared to these patients without cancer.[4] Unlike OVT in the postpuerperial setting, the OVT associated with malignancies can be asymptomatic and usually detected incidentally on imaging.

Usual methods of imaging OVT include ultrasonography, magnetic resonance imaging and multidetector computed tomography (MDCT). Identifying normal ovarian vein on CT may be difficult. It usually originates from the broad ligament near the ovary; communicate with uterine plexus, runs anterior to psoas muscle/ureter, and drains into inferior vena cava (on right) or left renal vein (on left). Identification of the ovarian vein is useful in imaging gynecological cancers as it helps to ascertain the origin of the mass whether it arises from adnexa or not.[5] On MDCT, the OVT appears to be a filling defect within ovarian vein, which may or may not be enlarged. On coronal reconstruction, this appears like a tubular structure in the retroperitoneum.[6]

With increasing use of FDG PET/CT in various gynecological malignancies, incidental observation of tumor thrombosis on PET/CT is not uncommon.[7] In addition to diagnosing thrombus, PET/CT helps in differentiating nonmetabolically active bland thrombus from metabolically active tumor thrombus which can have treatment implications with respect to anticoagulation. There is no strong evidence currently to suggest routine anticoagulation in patients with tumor thrombus as these resolve spontaneously.[4] Identification of OVT on FDG PET/CT to our knowledge has been reported only once in literature.[8] This case re-illustrates the potential clinical utility of PET/CT in imaging tumor thrombus.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Takach TJ, Cervera RD, Gregoric ID. Ovarian vein and caval thrombosis. Tex Heart Inst J 2005;32:579-82.  Back to cited text no. 1
[PUBMED]    
2.
Witlin AG, Sibai BM. Postpartum ovarian vein thrombosis after vaginal delivery: A report of 11 cases. Obstet Gynecol 1995;85(5 Pt 1):775-80.  Back to cited text no. 2
    
3.
Gakhal MS, Levy HM, Spina M, Wrigley C. Ovarian vein thrombosis: Analysis of patient age, etiology, and side of involvement. Del Med J 2013;85:45-50.  Back to cited text no. 3
[PUBMED]    
4.
Wysokinska EM, Hodge D, McBane RD 2nd. Ovarian vein thrombosis: Incidence of recurrent venous thromboembolism and survival. Thromb Haemost 2006;96:126-31.  Back to cited text no. 4
    
5.
Karaosmanoglu D, Karcaaltincaba M, Karcaaltincaba D, Akata D, Ozmen M. MDCT of the ovarian vein: Normal anatomy and pathology. AJR Am J Roentgenol 2009;192:295-9.  Back to cited text no. 5
    
6.
Sharma P, Abdi S. Ovarian vein thrombosis. Clin Radiol 2012;67:893-8.  Back to cited text no. 6
[PUBMED]    
7.
Erhamamci S, Reyhan M, Nursal GN, Torun N, Yapar AF. Incidental diagnosis of tumor thrombosis on FDG PET/CT imaging. Rev Esp Med Nucl Imagen Mol 2015;34:287-94.  Back to cited text no. 7
[PUBMED]    
8.
Luo Y, Feng R, Li F. FDG PET/CT appearance of tumor thrombus of ovarian vessels masquerading as retroperitoneal fibrosis. Clin Nucl Med 2015;40:501-3.  Back to cited text no. 8
[PUBMED]    


    Figures

  [Figure 1], [Figure 2]



 

Top
  
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
    References
    Article Figures

 Article Access Statistics
    Viewed601    
    Printed3    
    Emailed0    
    PDF Downloaded57    
    Comments [Add]    

Recommend this journal