April 5, 2009

Pelvic Congestion Syndrome

Fig. 1: Axial CT image of a 42-year-old woman with chronic pelvic pain shows dilatation of bilateral ovarian veins (arrows).
Fig. 2: Axial CT image of the same patient at the level of the uterus shows multiple dilated veins in the pelvic cavity, indicating pelvic varices.

Pelvic Congestion Syndrome
  • Multifactorial disease that may be from anatomical obstruction of ovarian veins, or secondary to other diseases such as valvular incompetence, portal hypertension.
  • Dilated, tortuous and congested veins with retrograde flow through ovarian veins
  • Signs and symptoms: deep, dull chronic pelvic pain, dyspareunia, dysmenorrhea, postcoital pain, varicose veins, tenderness on palpation
Imaging Findings
  • Not all pelvic varices represent pelvic congestion syndrome!
  • Dilated ovarian veins (normal 3-4 mm, borderline 4-8 mm, abnormal > 8 mm)
  • Reflux of contrast into ovarian vein(s)
  • Slow (3 cm/s) or reverse flow in ovarian veins
  • Polycystic changes of ovary
1. Kuligowska E, et al. Pelvic pain: overlooked and underdiagnosed gynecologic conditions. Radiographics 2005;25:3-20.
2. Karaosmanoglu D, et al. MDCT of the ovarian vein: normal anatomy and pathology. AJR 2009;192:295-299.

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