Venous Thrombosis in the Broad Ligament: Is it a Predictor of Postoperative Pulmonary Embolism in Gynecological Cancer Patients? A Case-control Study

Pulmonary embolism is a common postoperative complication in gynecological oncology patients and is often fatal. A substantial proportion of venous thrombi responsible for pulmonary emboli originate in the pelvic veins. The significance of thrombi in the veins of the broad ligament identified in surgical specimens is unknown. In a case-control study, women with postoperative pulmonary embolism (cases) were identified from the Gynecological Oncology service at the Washington Hospital Center and compared with consecutive surgical pathology accessions (controls). Only the broad ligament veins were evaluated for the presence of organizing thrombi. Eight patients, all of whom had a gynecological malignancy, were diagnosed postoperatively with pulmonary embolism. Six were diagnosed clinically by spiral CT from 4 to 115 days after surgery, and two were diagnosed by open lung biopsy of a new pulmonary lesion approximately 1 year postoperatively. None of the cases was shown to have thrombi in the broad ligament veins. Thrombi in the broad ligament veins were present in three of 30 control patients with malignancies. Among 56 controls without malignancies, 3 had broad ligament thrombi. These findings suggest that the presence of organizing thrombi in the broad ligament veins does not predict postoperative pulmonary embolism.