A 23 year old female presented to the ED with chest pain and shortness of breath. Having no significant past cardiopulmonary medical history in a young, healthy female, the etiology of the patient’s symptoms was vague. Diagnostic tests returned with a normal EKG, cardiac enzymes, chest xray, and an oxygen saturation of 98%. With no illicit drug use and no medications except IVF hormone injections for an upcoming egg donation, the patient was considered to be realtively healthy. A bedside ultrasound was performed to assess for any cardiac, pulmonary, or abdominal etiologies. Pulmonary ultrasound (A) exhibited small bilateral pleural effusions. Lower abdominal ultrasound showed free fluid in the posterior cul-de-sac (B), as well as multiple ovarian follicles bilaterally (C). With the patient’s history of IVF hormone treatment and her ultrasound findings she was diagnosed with ovarian hyperstimulation syndrome (OHSS).
Ovarian hyperstimulation syndrome occurs in approximately 5% of women underoging IVF. In addition to multiple ovarian follicles due to hormonal stimulation, oftentimes women with OHSS also present with free fluid (abdominal, pleural, cardiac). Research of the pathophysiology suggests that an ovarian factor made from the presence of multiple corpora lutea increases capially permability causing a fluid shift from intravascular to extravascular.
Three distinct findings are usually found on the ultrasound of women with OHSS:
1. bilateral symmetric enlargement of ovaries
2. multiple cysts of different sizes (creates a spoke-wheel appearance)
3. free fluid findings (ascites, pleural, and/or pericardial effusion)