Pelvic varices
Updates to Article Attributes
Pelvic congestion syndrome (some prefer pelvic venous insufficiency9) is a condition that results from retrograde flow through incompetent valves in ovarian veins. It is one ofa commonly missed and potentially treatable-treatable cause of chronic abdominal or pelvicabdominopelvic 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%.
Clinical presentation
Patients often have noncyclicalnon-cyclical chronic (typically dull and aching) pelvic pain. In certain cases there may be thigh or vulvar varices. It is often considered a diagnosis of exclusion.
Pathology
Pelvic congestion syndrome 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 >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
adnexaeadnexa with reversed venous flow on colour Doppler, especially after Valsalvamaneuvermanoeuvre - the venous calibres may increase on real time during Valsalva
- prominent myometrial veins may also be present 1-8
.
CT
Contrast enhanced CT typically shows dilated pelvic and ovarian veins. The supine position during scanning may underestimate the size of venous dilatation.
MRI
MR venography
May show dilated veins. Time of flight (TOF) imaging can be performed where contrast is not required.
Signal characteristics
- T1: seen as flow voids
- T2: mostly high signal but but can vary dependent on velocities from low signal to iso signal
- GE: high signal
Treatment and prognosis
Treatment options include coil embolisation of the gonadal vein: ovarian vein embolisation. Surgical (e.g. laparoscopic) ligation of the ovarian vein may also be an option in selected cases. The presence of multiple collaterals between iliac and ovarian venous plexuses may cause recurrence of symptoms.
History and etymology
Pelvic congestion syndrome was first described in 1857 by Louis Alfred Richet (1816-1891), a French anatomist and surgeon 10.
-<p><strong>Pelvic congestion syndrome</strong> 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. </p><h4>Epidemiology</h4><p>It tends to be more common in multiparous, premenopausal women who typically present with chronic pelvic pain for more than 6 months <sup>1</sup>. The overall population prevalence may approach ~10%.</p><h4>Clinical presentation</h4><p>Patients often have noncyclical chronic (typically dull and aching) pelvic pain. In certain cases there may be thigh or vulvar varices. It is often considered a diagnosis of exclusion.</p><h4>Pathology</h4><p>Pelvic congestion syndrome is considered the female equivalent to a testicular <a href="/articles/varicocele">varicocele</a>. It is caused by:</p><ul>- +<p><strong>Pelvic congestion syndrome</strong> (some prefer <strong>pelvic venous insufficiency</strong> <sup>9</sup>) is a condition that results from retrograde flow through incompetent valves in ovarian veins. It is a commonly missed and potentially-treatable cause of chronic abdominopelvic pain. </p><h4>Epidemiology</h4><p>It tends to be more common in multiparous, premenopausal women who typically present with chronic pelvic pain for more than 6 months <sup>1</sup>. The overall population prevalence may approach ~10%.</p><h4>Clinical presentation</h4><p>Patients often have non-cyclical chronic (typically dull and aching) pelvic pain. In certain cases there may be thigh or vulvar varices. It is often considered a diagnosis of exclusion.</p><h4>Pathology</h4><p>Pelvic congestion syndrome is considered the female equivalent to a testicular <a href="/articles/varicocele">varicocele</a>. It is caused by:</p><ul>
-<li>may show multiple dilated veins in the adnexae with reversed venous flow on colour Doppler, especially after <a href="/articles/valsalva-manoeuvre">Valsalva maneuver</a>- +<li>may show multiple dilated veins in the adnexa with reversed venous flow on colour Doppler, especially after <a href="/articles/valsalva-manoeuvre">Valsalva manoeuvre</a>
-<li>prominent myometrial veins may also be present <sup>1-8</sup>.</li>- +<li>prominent myometrial veins may also be present <sup>1-8</sup>
- +</li>
-</ul><h4>Treatment and prognosis</h4><p>Treatment options include coil embolisation of the gonadal vein: <a href="/articles/ovarian-vein-embolisation-1">ovarian vein embolisation</a>. Surgical (e.g. laparoscopic) ligation of the ovarian vein may also be an option in selected cases. The presence of multiple collaterals between iliac and ovarian venous plexuses may cause recurrence of symptoms.</p>- +</ul><h4>Treatment and prognosis</h4><p>Treatment options include coil embolisation of the gonadal vein: <a href="/articles/ovarian-vein-embolisation-1">ovarian vein embolisation</a>. Surgical (e.g. laparoscopic) ligation of the ovarian vein may also be an option in selected cases. The presence of multiple collaterals between iliac and ovarian venous plexuses may cause recurrence of symptoms.</p><h4>History and etymology</h4><p>Pelvic congestion syndrome was first described in 1857 by <strong>Louis Alfred Richet </strong>(1816-1891), a French anatomist and surgeon <sup>10</sup>.</p>
References changed:
- 9. Knuttinen MG, Xie K, Jani A, Palumbo A, Carrillo T, Mar W. Pelvic venous insufficiency: imaging diagnosis, treatment approaches, and therapeutic issues. (2015) AJR. American journal of roentgenology. 204 (2): 448-58. <a href="https://doi.org/10.2214/AJR.14.12709">doi:10.2214/AJR.14.12709</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/25615769">Pubmed</a> <span class="ref_v4"></span>
- 10. Djembi YR, Viard B, Trouilloud P, Trost O, Salomon C. [Alfred-Louis-Dominique Richet (1816-1891): education, anatomy and surgery]. (2015) Morphologie : bulletin de l'Association des anatomistes. 99 (324): 14-7. <a href="https://doi.org/10.1016/j.morpho.2014.11.002">doi:10.1016/j.morpho.2014.11.002</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/25543230">Pubmed</a> <span class="ref_v4"></span>
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