Combined jugular and subclavian vein thrombosis following assisted reproductive technology—new observation  Ophira Salomon, M.D., Ginette Schiby, M.D., Zehava Heiman, M.D., Kamila Avivi, Ph.D., Carol Sigal, M.D., David Levran, M.D., Jeushua Dor, M.D., Yacov Itzchak, M.D., Ph.D.  Fertility and Sterility  Volume 92, Issue 2, Pages 620-625 (August 2009) DOI: 10.1016/j.fertnstert.2008.07.1708 Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions

Figure 1 (A) Histology of the cystic cavity shown in the center. Around the cystic cavity fibrous tissue, lymphoid follicles (short arrows) and lakes of edematous fluid (long arrows) are present. The cystic lumen shows three thin fibrous septae (H&E 10 × 100) (B) Higher magnification of the same cystic cavity with no cell lining (long arrows). A reactive organized lymphoid follicle in the surrounding fibrous tissue is seen (short arrows) (H&E 40 × 100). Fertility and Sterility 2009 92, 620-625DOI: (10.1016/j.fertnstert.2008.07.1708) Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions

Figure 2 (A) Ultrasound image demonstrates a multiloculated mass comprising three cystic lesions of 14, 11, and 9 mm, respectively (B) Heavily T2-weighted MRI image of coronal section of the same patient showing three lesions compressing the jugular and subclavian veins at their junction. Small lesions are also demonstrated on the right side. (C) Heavily T2-weighted MRI image of axial section showing a cluster of small cysts, compressing the right proximal subclavian vein.(D) Heavily T2-weighted MRI image of coronal section of the same patient showing a bundle of multiple cysts at the base of the right side of the neck compressing the jugular and subclavian veins (E) Color Doppler ultrasound showing subclavian vein with open lumen and normal flow after a month of treatment with low molecular weight heparin. Above the proximal segment of the jugular and subclavian junction there are round fluid-filled interconnected lesions with no flow in them (F) Heavily T2-weighted MRI image of axial section showing clusters of small cysts at the right and left sides of the base of the neck 2.5 years after bilateral jugular and subclavian vein thrombosis. Fertility and Sterility 2009 92, 620-625DOI: (10.1016/j.fertnstert.2008.07.1708) Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions

Figure 3 A suggested model for development of jugular and subclavian vein thrombosis following assisted reproductive technology in the presence of OHSS. Fertility and Sterility 2009 92, 620-625DOI: (10.1016/j.fertnstert.2008.07.1708) Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions