Case Report ABSTRACTS

Bilateral Internal Jugular Thrombosis complicating Ovarian Hyperstimulation Syndrome
Bhavesh Patel
Imperial College London
Sanjay Krishnamoorthy
Hannah Skene
Case Report
A 37 year old lady presented to the emergency department complaining of tightness in her chest and pain
in her left neck. She described the pain as an intermittent "squeezing pain", non-pleuritic in nature. She was
feeling generally lethargic and had nasal congestion for a week prior to presentation. Following a
successful cycle of IVF, she was 10 weeks pregnant. The confirmatory scan further diagnosed mild ovarian
hyperstimulation syndrome (OHSS). She had no significant past medical history.
Physical examination was normal and vital signs normal. An electrocardiogram tracing was normal. Her
blood tests showed a marginally raised white cell count with increased neutrophils. She was re-assured, at
the time, that this was most likely a mild viral infection, and discharged.
She re-presented to the emergency department one week later, complaining of ongoing pain and tightness
in her chest, and now complained of pain on both sides of her neck. Physical examination of her neck
revealed tender, well defined supraclavicular fullness in her neck. There was no palpable lymphadenopathy
and her carotid arteries were palpable bilaterally. A bedside ultrasound was performed which confirmed
a diagnosis of bilateral subclavian vein thrombosis.
As the patient was within her first trimester, she was managed with treatment dose of low molecular weight
heparin for the duration of her pregnancy. A repeat ultrasound of her neck showed decreased thrombotic
burden. She delivered her baby at term with no further complication from the OHSS.
This case illustrated a number of valuable clinical lessons for acute medical physicians:
Thrombotic disease is an important complication of Ovarian hyperstimulation syndrome.
Due to the rarity of upper extremity DVT, a secondary cause should always be considered
thrombosis
Bed side ultrasound can be used to diagnose jugular vein thrombosis.
Low molecular weight heparin is the treatment of choice for DVT in pregnancy