Korean J Leg Med.  2011 May;35(1):57-61.

An Autopsy Case of Severe Ovarian Hyperstimulation Syndrome with Multifocal Arterial and Venous Thromboembolism

• Kim HS
• Kim M
• Seo IS
• Kwon TJ
• Ha H
• Lee BW

Abstract

Ovarian hyperstimulation syndrome (OHSS) is a rare, serious complication of assisted reproductive procedures for fertility treatment. Although most cases of OHSS are mild to moderate in nature, its severe form causes life-threatening complications including respiratory distress, renal failure, liver dysfunction, and thromboembolism because of hemoconcentration. We herein report a rare autopsy case of severe OHSS in a 29-year-old woman who underwent controlled ovulation induction. Three days after the administration of human chorionic gonadotropin, she developed abdominal pain and distension. Two days after, she suddenly developed respiratory arrest, hypotension and semicomatose mentality and died of respiratory failure. At autopsy, multifocal thromboembolism was detected in the internal carotid arteries, internal jugular veins, pulmonary arteries, inferior vena cava, renal arteries, and deep leg veins. And there were cerebral edema, anasarca, pleural effusion, massive pulmonary edema, ascites, and bilateral ovarian enlargement. Microscopically, the bilateral ovaries showed multiple well-developed cyst formations consisting of membrana granulosa and theca interna. To the best of our knowledge, this is the first autopsy report of severe OHSS with multifocal arterial and venous thromboembolism.

Keyword

ovarian hyperstimulation syndrome; thromboembolism; autopsy

MeSH Terms

Abdominal Pain
Adult
Ascites
Autopsy
Brain Edema
Carotid Artery, Internal
Chorionic Gonadotropin
Edema
Female
Fertility
Humans
Hypotension
Jugular Veins
Leg
Liver Diseases
Ovarian Hyperstimulation Syndrome
Ovary
Ovulation Induction
Pleural Effusion
Pulmonary Artery
Pulmonary Edema
Renal Artery
Renal Insufficiency
Respiratory Insufficiency
Theca Cells
Thromboembolism
Veins
Vena Cava, Inferior
Venous Thromboembolism
Chorionic Gonadotropin