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Pelvic pain is a common gynaecological complaint, sometimes without any obvious etiology. We report a case of pelvic congestion syndrome, an often overlooked cause of pelvic pain, diagnosed by helical computed tomography. This seems to be an effective and noninvasive imaging modality.

A 54-year-old man with right ventricular (RV) arrhythmogenic dysplasia and episodes of sustained ventricular tachycardia (VT) was admitted at another institution, where he underwent a RV biopsy complicated by an RV perforation and tamponade. A thoracotomy was performed and the RV was sutured. Soon afterward, he developed a superior vena cava syndrome. Several weeks later, a Medtronic GEM 7221 ICD was implanted via a thoracotomy at a left prepectoral site. A Medtronic Transvene RV 6936 tripolar lead (two sensing electrodes, one defibrillation coil, and active fixation) was inserted via the right atrium into the RV apex. The lead was tunneled to the left subclavicular region and connected to the ICD. At implantation, RV pacing/sensing thresholds and RV pacing Address for reprints: Roland Stroobandt, Figure 1. Stored intracardiac electrograms recorded in the sensing electrodes representing the bipolar electrogram between the V tip to V ring (top: 1 mV/2.5 mm) and the shocking electrodes (can to the high-voltage RV coil − HVB = RV coil) at the bottom (1 mV/10 mm). Ventricular fibrillation (VF) was induced by a shock on T-wave of 5 J. VF was appropriately detected (FD) and terminated by a shock of 20 J. After the shock, the device demonstrated oversensing of false signals (arrows) by the sensing electrodes (V tip to V ring) at a sensitivity of 0.3 mV. FD = VF detection; VS = ventricular sense; CE = charge end; CD = cardioversion/defibrillation pulse; VP = ventricular pace; FS = VF sense.lead impedance were normal and the defibrillation threshold was <20 J. Follow-up for several years on amiodarone therapy documented no shocks, but the device recorded episodes of nonsustained VT. No other arrhythmias including oversensing were observed.Seven years postimplantation, the ICD was replaced for battery depletion. The original RV lead exhibited satisfactory parameters: RV pacing threshold was 1.3 V at 0.5 ms, the R-wave amplitude measured 6.9 mV, and the pacing lead impedance was 401 at 5.0 V. As the presence of a superior vena cava syndrome precluded transvenous insertion of a new lead, a Medtronic ICD Maximo VR 7332 Cx was connected to the old Transvene lead. A 20-J test shock was successful in terminating ventricular fibrillation, and the shock impedance measured 40 . Shortly after the shock, false signals were detected on the bipolar ventricular electrogram (ICD sensing electrodes), resulting in oversensing at a sensitivity of 0.15 and 0.3 mV ( Figs. 1 and 2). Corresponding false signals were C

The use of SH echocardiography decreases the number of unscored segments. This results in an important gain in correlation and agreement for EF determination between echo and SPECT, and in a considerable decline of the interobserver variability for the echo-determined WMSI. WMSI determined by MIBI gated SPECT correlated closely with the SH WMSI, and agreement between both methods was excellent.

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