F10The sonographic diagnosis of uterine venous plexus thrombosis made by transvaginal B‐mode and color Doppler scanning: two case reports

Background Transvaginal sonography (TVS) enables a close imaging of the pelvic organs providing a clear imaging of the pelvic vessels. To the best of our knowledge – this is the first report of the diagnosis of uterine venous plexus thrombosis using this technique. Case reports 1st case: 38-year-old patient diagnosed as having a left tubal ectopic pregnancy in the 7th week of gestation. On TVS examination the ipsilateral uterine plexus thrombosis was found. The blood clots were demonstrated as elongated echogenic structures within the dilated veins. The thrombi showed swinging movements caused by the surrounding blood flow. This effect could also be provoked by gentle transducer pressure. On the transverse view of the affected veins the thrombi appeared as free round structures in the lumen. The blood flow around the thrombi was seen on color Doppler. 2nd case: 36-year-old patient with fetal death in the 19th week of gestation. Two days after the induced labor the patient experienced excessive vaginal bleeding. A placental residue was confirmed by TVS. Upon examination the engorged uterine venous plexuses were seen with a thrombus on the right side. The sonographic description of the clot was as in the first case. There were no signs of thromboembolic disease in both cases. The deep leg veins and iliac veins were studied and found to be normal. The uterine plexus thrombi could not be detected by transabdominal sonography and were only seen by TVS. Over 3 months of anticoagulation therapy the clots gradually disappeared in both cases. Conclusions In both patients the transvaginal sonographic diagnosis of uterine venous plexus thrombosis was accidental. There is not enough data in the medical literature to determine the evidence based approach to such cases. Nevertheless, focusing on the pelvic veins may reveal important findings with significant clinical implications.