Selective Ovarian Venography Is Gold Standard for Pelvic Congestion Syndrome

Background
Chronic pelvic pain accounts for 10% to 40% of gynecologic referrals. Pelvic congestion syndrome (PCS) results from the retrograde flow of an incompetent ovarian vein and is one possible cause of chronic pelvic pain.

In this article, it will review some of the diagnostic and therapeutic roles of radiologists in managing PCS.

Radiologists performing imaging for patients with chronic pelvic pain should be aware of the imaging appearances of PCS and should know that transcatheter embolization is a viable treatment alternative.

Results
After appropriate clinical evaluation, a pelvic ultrasound is the first-line investigation. Multiple dilated venous plexuses around the ovary and uterus can be seen. CT and MRI are then used to confirm the diagnosis by finding the abnormal dilated veins in the pelvis.

However, MRI and CT may underestimate pelvic venous pathology because the conventional cross-sectional images performed in the supine position may result in non-prominent ovarian and pelvic venous varices.

CT and MRI are usually followed by direct venography with subsequent embolization of the gonadal veins.

Conclusions
PCS is a common under-recognized condition causing chronic pelvic pain that can be treated with catheter embolization.

Author: Sohail Contractor, MD

Reference:

Ganeshan A, Upponi S, et al. Chronic Pelvic Pain Due to Pelvic Congestion Syndrome: The Role of Diagnostic and Interventional Radiology. Cardiovasc Intervent Radiol; 2007; 30 (November-December): 1105-1111