Chronic Pelvic Pain due to Pelvic Congestion Syndrome: The Role of Diagnostic and Interventional Radiology

Ganeshan, Arul; Upponi, Sara; Hon, Lye-Quen; Uthappa, Mangerira; Warakaulle, Dinuke; Uberoi, Raman

doi:10.1007/s00270-007-9160-0

Cited by 155 publications

(164 citation statements)

References 19 publications

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“…Pelvic pain, which is worse during the premenstrual period and pregnancy, is exacerbated by fatigue and standing and often accompanied by a feeling of fullness in the legs may be seen. These typical clinical findings are helpful in the diagnosis of PCS in younger patients (4). Varices of the vulva and posteromedial thigh due to insufficiency of hypogastric or ovarian veins are helpful clinical signs pointing to pelvic congestion syndrome as cause of pelvic pain, but are seen only in a minority of patients (7).…”

Section: Discussionmentioning

confidence: 99%

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Use of time resolved magnetic resonance imaging in the diagnosis of pelvic congestion syndrome

Pandey

Shaikh

Viswamitra

et al. 2010

Magnetic Resonance Imaging

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We describe the efficacy of time-resolved MR angiography in diagnosing a case of pelvic congestion syndrome (PCS). MR angiography, using four-dimensional (4D) TRAK (Time-Resolved Angiography using Keyhole) technique was used in an 81-year-old woman presenting with low backache, pelvic pain, and left pelvic fullness. Dynamic images were obtained in multiple vascular phases including arterial, arteriovenous, and venous phases. The high temporal resolution of 4D TRAK could demonstrate early retrograde left ovarian vein filling as well as multiple dilated pelvic varices, allowing the prospective diagnosis of PCS to be made. Although uncommon in this age group, the diagnosis was subsequently confirmed on conventional catheter venography with symptomatic relief after successful embolization of the incompetent left ovarian vein. The MRA and correlative catheter venography images are presented in this case report.

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Section: Discussionmentioning

confidence: 99%

“…The etiology of PCS while poorly understood may be from incompetent valves in ovarian or pelvic veins, with associated hormonal factors (4). It is estimated that approximately 10% of women have incompetent ovarian vein valves, of these, approximately 40% experience chronic pelvic pain directly as a result of venous congestion (5,6).…”

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confidence: 99%

Use of time resolved magnetic resonance imaging in the diagnosis of pelvic congestion syndrome

Pandey

Shaikh

Viswamitra

et al. 2010

Magnetic Resonance Imaging

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“…During pregnancy, the diameter of the ovarian veins increases several fold. According to the literature, multiple pregnancies are a major factor in the pathogenesis and progression of pelvic varicosis, which is considered to be a secondary phenomenon in multiparous women (3,9).…”

Section: Discussionmentioning

confidence: 99%

Pregnancy after embolization of ovarian varicocele: report of two cases

Таразов

Prozorovskij²,

Rumiantseva³

2009

Diagn Interv Radiol

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Ovarian varicocele is a well-known cause of pelvic pain in women (1-3). Surgical or laparoscopic ligation, or retrograde transcatheter embolization is successfully used for treatment of symptomatic cases (l-6).In 1991, Galkin et al. (7) hypothesized that long-lasting ovarian varicocele might cause hypofunction of the ovaries and, similar to testicular varicocele, could be a cause of infertility. This hypothesis is not yet proven in the medical literature. We report two cases of pregnancy in women with infertility after successful transcatheter embolization of ovarian varices. Case reports Case 1A 43-year-old woman presented with chronic pelvic pain of three years duration. Her pain increased after physical activity and during menses. She had given birth to a full-term baby 20 years prior to presentation. She has not become pregnant since that time, despite a lack of contraception during the last 7 years. Repeated gynecologic examinations including hysterosalpingography did not reveal any source of pelvic pain. No disorder of hormonal milieu was noted on endocrine evaluation.Abdominal ultrasound did not reveal any gynecologic pathology such as leiomyoma, adenomyosis, or endometriosis, but it showed marked dilatation of veins around the left ovary. The diameter of the left ovarian vein trunk was 12 mm.The presence of left ovarian varicocele was confirmed by selective retrograde venography. The right transjugular approach was used, because the patient had several large moles on both groins. A Headhunter 1 catheter (Cordis, Bridgewater, New Jersey, USA) was placed in the left renal vein, and then in the left ovarian vein. Embolization of the dilated left ovarian vein was performed with three long and four short homemade steel coils 10-12 mm in diameter (Fig. 1). The right ovarian vein was not dilated.During the next month, the patient had significant reduction of pelvic pain, which eventually disappeared completely. Ultrasound (US) examination showed occlusion and fibrosis of the left ovarian vein, and disappearance of pelvic varices. Three months after the procedure, the patient became pregnant. The pregnancy was normal, and resulted in an easy delivery. Case 2A 25-year-old woman was referred to our hospital with a 4-year history of infertility. She had never been pregnant. She complained of periodic mild pelvic pain and dysmenorrhea. Her symptoms were aggravated by standing for a long time, and they increased during sexual activity. No pathological changes were observed on gynecologic examination or en- ABSTRACT We describe two cases of left-sided ovarian varicocele in patients with infertility. Pregnancy occurred in both women after successful retrograde venous embolization. Ovarian varicocele may be associated with infertility in some patients. INTERVENTIONAL RADIOLOGY

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“…The causes of ovarian varicoceles are multifactorial, involving both mechanical and hormonal factors. Dilatation of the ovarian veins can result in vascular incompetence and retrograde blood flow [3].On either CT or magnetic resonance (MR) imaging studies, pelvic varices in PCS appear as dilated, tortuous, enhancing tubular structures near the ovaries and uterus [4]. In addition, the extension of varices to the broad ligament and paravaginal venous plexus can be appreciated [5].…”

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confidence: 99%

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Pelvic Congestion Syndrome Initially Detected by Contrast-Enhanced F-18 FDG-PET/CT

Kim

et al. 2012

Nucl Med Mol Imaging

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Pelvic congestion syndrome (PCS) is said to occur as a result of retrograde flow in an incompetent ovarian vein. Ovarian vein incompetence is seen in approximately 10 % of women, and up to 60 % with this abnormality can develop PCS [1]. The etiology of PCS is poorly understood and is likely to be multifactorial. Absence of ovarian vein valves is an important factor in its development [2]. The causes of ovarian varicoceles are multifactorial, involving both mechanical and hormonal factors. Dilatation of the ovarian veins can result in vascular incompetence and retrograde blood flow [3].On either CT or magnetic resonance (MR) imaging studies, pelvic varices in PCS appear as dilated, tortuous, enhancing tubular structures near the ovaries and uterus [4]. In addition, the extension of varices to the broad ligament and paravaginal venous plexus can be appreciated [5]. With CT, the tubular nature of these structures and the pattern of enhancement after intravenous contrast medium administration distinguish them from lymphadenopathy or adnexal masses [6]. Unlike such masses, pelvic varices appear isodense with other veins after contrast enhancement [7].Contrast-enhanced CT data as part of the combined PET/ CT examination provide additional information when compared with non-enhanced PET/CT. Because CT data supply the anatomic background for PET, the most important benefit relates to more precise anatomic localization of pathology by differentiation of the lesion from its surrounding structures [8]. By supporting lesion detection and characterization, CT contrast agents can be of additional value in F-18 FDG non-avid disease [9]. As in the presented case, careful review of CT images in contrastenhanced PET/CT enables the detection of F-18 FDG nonavid disease such as PCS (Fig. 1). As contrast-enhanced F-18 FDG PET/CT had been performed frequently, being familiar with the findings of PCS on the contrast-enhanced CT images would have been helpful for the nuclear medicine physicians.

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Chronic Pelvic Pain due to Pelvic Congestion Syndrome: The Role of Diagnostic and Interventional Radiology

Cited by 155 publications

References 19 publications

Use of time resolved magnetic resonance imaging in the diagnosis of pelvic congestion syndrome

Use of time resolved magnetic resonance imaging in the diagnosis of pelvic congestion syndrome

Pregnancy after embolization of ovarian varicocele: report of two cases

Pelvic Congestion Syndrome Initially Detected by Contrast-Enhanced F-18 FDG-PET/CT

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