Radiology Quiz 29070 | Radiopaedia.org

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What is the most likely clinical diagnosis?

Patient history strongly suggests ovarian hyperstimulation syndrome. Dyspnea suggests a severe grade (4 or 5).

Name possible differential diagnoses on clinical grounds.

The list is long and may include ovarian torsion, hemorrhagic or ruptured ovarian cyst, salpingitis, ectopic pregnancy, pulmonary oedema and acute respiratory distress syndrome (ARDS).

Question 3

True or false: There is evidence of abdominal infection.

Show Answer

False: There are no localized or organized collections. Leukocytosis in OHSS is most often due to hemoconcentration, although infections occur in OHSS and are possibly attributable to decreased IgG and IgA levels. Urinary infections are believed to predominate.

Question 4

True or False: Pleural effusion is not seen in OHSS and the asymmetric appearance is in favor of empyema or parapneumonic effusion.

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False: Pleural effusion may develop in up to 20% of severe OHSS. Although pleural effusions in OHSS usually are bilateral, asymmetric and even unilateral pleural effusion (more often right-sided) has been reported.

Question 5

True or False: Thoracocentesis is contraindicated in patients with OHSS due to altered coagulation state.

Show Answer

False: In symptomatic pleural effusion thoracentesis is indicated to relieve symptoms. Obtaining blood samples including coagulation state is standard of care.

Background history:

Ovulation induction. In vitro fertilization nine days prior to admittance.
Clinical findings include abdominal distortion and dyspnea. No fevers. No focal abdominal tenderness.
Blood samples reveal moderate leukocytosis, further details temporarily withheld.