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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. 

Epidemiology

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%.

Pathology

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

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 5-6 mm 4.

Ultrasound
  • 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
CT

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.


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