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
  

References:
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.