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Pelvic congestion syndrome

The pelvic congestion syndrome is a condition that results from congestion of the pelvic veins. It is one of commonly missed and potentially treatable cause of chronic abdominal or pelvic pain. 

Epidemiology

It tends to prevail in multiparous, pre-menopausal women who typically present with chronic pelvic pain for more than 6 months 1. The overall population prevalence may approach ~ 10 %.

Pathophysiology

It is considered the female equivalent to a testicular varicocele 

It is caused by :

  • venous obstruction such as retro aortic 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

Radiographic features

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 8 mm 4.

Pelvic ultrasound

May show multiple dilated veins in the adnexae with venous colour flow on colour Doppler.

CT

Contrast enhanced CT typically shows dilated pelvic and ovarian veins

Treatment

Treatment options include coil embolisation of the gonadal vein - ovarian vein embolisation.

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