Pelvic congestion syndrome
Pelvic congestion syndrome is a condition that results from retrograde flow through incompetent valves in ovarian veins. It is one of commonly missed and potentially treatable cause of chronic abdominal or pelvic pain.
It tends to be more common in multiparous, premenopausal women who typically present with chronic pelvic pain for more than 6 months 1. The overall population prevalence may approach ~10%.
It is considered the female equivalent to a testicular varicocele.
It is caused by:
- venous obstruction such as retroaortic left renal vein
- compression of left renal vein by SMA also known as nutcracker phenomenon, or right iliac vein compression
- incompetent valves in ovarian vein
The diagnosis of pelvic congestion syndrome is established by the demonstration of multiple dilated, tortuous parauterine veins with a width greater than 4 mm or an ovarian vein diameter greater than 5-6 mm 4.
- ovarian vein >5-6 mm (positive predictive value of 71-83%)
- may show multiple dilated veins in the adnexae with venous flow on colour Doppler, especially after Valsalva maneuver
Contrast enhanced CT typically shows dilated pelvic and ovarian veins.
Treatment and prognosis
Treatment options include coil embolisation of the gonadal vein: ovarian vein embolisation.
Ultrasound - gynaecology
- ultrasound (introduction)
- acute pelvic pain
- chronic pelvic pain
- Mullerian duct anomalies
- ovarian torsion
- pelvic inflammatory disease
- ovarian cysts and masses
- polycystic ovaries
- ovarian hyperstimulation syndrome
- post-hysterectomy ovary
- fallopian tube
- 1. Park SJ, Lim JW, Ko YT et-al. Diagnosis of pelvic congestion syndrome using transabdominal and transvaginal sonography. AJR Am J Roentgenol. 2004;182 (3): 683-8. AJR Am J Roentgenol (full text) - Pubmed citation
- 2. Umeoka S, Koyama T, Togashi K et-al. Vascular dilatation in the pelvis: identification with CT and MR imaging. Radiographics. 24 (1): 193-208. doi:10.1148/rg.241035061 - Pubmed citation
- 3. Venbrux AC, Chang AH, Kim HS et-al. Pelvic congestion syndrome (pelvic venous incompetence): impact of ovarian and internal iliac vein embolotherapy on menstrual cycle and chronic pelvic pain. J Vasc Interv Radiol. 2002;13 (2 Pt 1): 171-8. - Pubmed citation
- 4. Haaga JR, Boll D. CT and MRI of the whole body. Mosby. (2009) ISBN:0323053750. Read it at Google Books - Find it at Amazon
- 5. Ignacio EA, Dua R, Sarin S et-al. Pelvic congestion syndrome: diagnosis and treatment. Semin Intervent Radiol. 2008;25 (04): 361-8. doi:10.1055/s-0028-1102998 - Free text at pubmed - Pubmed citation
Synonyms & Alternative Spellings
|Synonyms or Alternative Spelling||Include in Listings?|
|Pelvic venous incompetence||✗|