Presentation
The patient presented with a personal history of a cesarean section and pain in the hypogastric region that worsened with menstruation.
Patient Data
In non-contrast series, the vascular path that originates in the left renal vein and ends in uterine topography can be visualized.
In the arterial phase: the increase in the density of the aorta and the aforementioned vascular path is observed, making the contralateral path evident. The vessels observed, due to their topography and origin, correspond to the right ovarian vein (tributary of the vena cava) and the left ovarian vein (tributary of the left renal vein).
In utero, a marked heterogeneous increase in density is observed, with a "varicose" appearance, which present similar Houndsfield units to the arterial vessels explored, and can be interpreted as a passage of arterial content (greater resistance) to the venous system (less resistance).
It is worth mentioning that the aortic-mesenteric compass presents an angulation of 45°, so compression of the left renal vein can be ruled out.
Case Discussion
Pelvic pain syndrome, female varicocele or pelvic congestion syndrome, is an entity caused by the dilation of the female gonadal venous system, whether primary (absence of valves) or secondary (traumatic, surgical).
In our patient, pelvic pain began months after having had a cesarean section, although she does not currently report any clinical symptoms, so it can be interpreted that the aforementioned entity presents latency periods where there will be no clinical manifestations, which makes its diagnosis difficult.
In our patient, not only the left gonadal vein is dilated, but also the contralateral one, which rules out lesions on only one side (May-Turner, Nutcracker), so the cause may be systemic or congenital, and the presence of fistulas or arteriovenous malformations cannot be ruled out.
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