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Pelvic Congestion Syndrome
Christine O. Menias, MD; Susan M. Ascher, MD, FISMRM, FSCBT/MR
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        TERMINOLOGY

        • Abbreviations

          • Pelvic congestion syndrome (PCS)
        • Synonyms

          • Pelvic venous incompetence, pelvic vein syndrome, pelvic varices
        • Definitions

          • Noncyclical chronic pelvic pain caused by dilated veins in uterus, broad ligament and ovarian plexus
            • Sidewall, paravaginal, and internal iliac varicosities may be present
            • Occasionally pelvic varices communicate with vulval and lower extremity varicosities
          • 1st described by Richet in 1857
            • Chronic dull pelvic pain, pressure and heaviness: Result of dilated tortuous and congested veins caused by retrograde flow through incompetent ovarian vein valves
          • Underdiagnosed treatable cause of chronic pelvic pain
            • Pelvic, gonadal varices found in approximately 1/2 of women with chronic pelvic pain

        IMAGING

        • General Features

          • CT Findings

            • MR Findings

              • Ultrasonographic Findings

                • Angiographic Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Gross Pathologic & Surgical Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  Selected References

                                  1. Nasser F et al: Safety, efficacy, and prognostic factors in endovascular treatment of pelvic congestion syndrome. Int J Gynaecol Obstet. 125(1):65-8, 2014
                                  2. Durham JD et al: Pelvic Congestion Syndrome. Semin Intervent Radiol. 30(4):372-380, 2013
                                  3. Lopera J et al: Role of interventional procedures in obstetrics/gynecology. Radiol Clin North Am. 51(6):1049-66, 2013
                                  4. Rane N et al: Pelvic congestion syndrome. Curr Probl Diagn Radiol. 42(4):135-40, 2013
                                  5. Ball E et al: Does pelvic venous congestion syndrome exist and can it be treated? Acta Obstet Gynecol Scand. 91(5):525-8, 2012
                                  6. Kies DD et al: Pelvic congestion syndrome: a review of current diagnostic and minimally invasive treatment modalities. Phlebology. 27 Suppl 1:52-7, 2012
                                  7. Smith PC: The outcome of treatment for pelvic congestion syndrome. Phlebology. 27 Suppl 1:74-7, 2012
                                  8. Freedman J et al: Pelvic congestion syndrome: the role of interventional radiology in the treatment of chronic pelvic pain. Postgrad Med J. 86(1022):704-10, 2010
                                  9. Asciutto G et al: Pelvic venous incompetence: reflux patterns and treatment results. Eur J Vasc Endovasc Surg. 38(3):381-6, 2009
                                  10. Asciutto G et al: MR venography in the detection of pelvic venous congestion. Eur J Vasc Endovasc Surg. 36(4):491-6, 2008
                                  11. Creton D et al: Embolisation of symptomatic pelvic veins in women presenting with non-saphenous varicose veins of pelvic origin - three-year follow-up. Eur J Vasc Endovasc Surg. 34(1):112-7, 2007
                                  12. Ganeshan A et al: Chronic pelvic pain due to pelvic congestion syndrome: the role of diagnostic and interventional radiology. Cardiovasc Intervent Radiol. 30(6):1105-11, 2007
                                  13. Liddle AD et al: Pelvic congestion syndrome: chronic pelvic pain caused by ovarian and internal iliac varices. Phlebology. 22(3):100-4, 2007
                                  14. Cheong Y et al: Chronic pelvic pain: aetiology and therapy. Best Pract Res Clin Obstet Gynaecol. 20(5):695-711, 2006
                                  15. Kim HS et al: Embolotherapy for pelvic congestion syndrome: long-term results. J Vasc Interv Radiol. 17(2 Pt 1):289-97, 2006
                                  16. Koc Z et al: Association of left renal vein variations and pelvic varices in abdominal MDCT. Eur Radiol. 2006
                                  17. Nicholson T et al: Pelvic congestion syndrome, who should we treat and how? Tech Vasc Interv Radiol. 9(1):19-23, 2006
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Pathology

                                        TERMINOLOGY

                                        • Abbreviations

                                          • Pelvic congestion syndrome (PCS)
                                        • Synonyms

                                          • Pelvic venous incompetence, pelvic vein syndrome, pelvic varices
                                        • Definitions

                                          • Noncyclical chronic pelvic pain caused by dilated veins in uterus, broad ligament and ovarian plexus
                                            • Sidewall, paravaginal, and internal iliac varicosities may be present
                                            • Occasionally pelvic varices communicate with vulval and lower extremity varicosities
                                          • 1st described by Richet in 1857
                                            • Chronic dull pelvic pain, pressure and heaviness: Result of dilated tortuous and congested veins caused by retrograde flow through incompetent ovarian vein valves
                                          • Underdiagnosed treatable cause of chronic pelvic pain
                                            • Pelvic, gonadal varices found in approximately 1/2 of women with chronic pelvic pain

                                        IMAGING

                                        • General Features

                                          • CT Findings

                                            • MR Findings

                                              • Ultrasonographic Findings

                                                • Angiographic Findings

                                                  • Imaging Recommendations

                                                    DIFFERENTIAL DIAGNOSIS

                                                      PATHOLOGY

                                                      • General Features

                                                        • Gross Pathologic & Surgical Features

                                                          CLINICAL ISSUES

                                                          • Presentation

                                                            • Demographics

                                                              • Treatment

                                                                DIAGNOSTIC CHECKLIST

                                                                • Consider

                                                                  Selected References

                                                                  1. Nasser F et al: Safety, efficacy, and prognostic factors in endovascular treatment of pelvic congestion syndrome. Int J Gynaecol Obstet. 125(1):65-8, 2014
                                                                  2. Durham JD et al: Pelvic Congestion Syndrome. Semin Intervent Radiol. 30(4):372-380, 2013
                                                                  3. Lopera J et al: Role of interventional procedures in obstetrics/gynecology. Radiol Clin North Am. 51(6):1049-66, 2013
                                                                  4. Rane N et al: Pelvic congestion syndrome. Curr Probl Diagn Radiol. 42(4):135-40, 2013
                                                                  5. Ball E et al: Does pelvic venous congestion syndrome exist and can it be treated? Acta Obstet Gynecol Scand. 91(5):525-8, 2012
                                                                  6. Kies DD et al: Pelvic congestion syndrome: a review of current diagnostic and minimally invasive treatment modalities. Phlebology. 27 Suppl 1:52-7, 2012
                                                                  7. Smith PC: The outcome of treatment for pelvic congestion syndrome. Phlebology. 27 Suppl 1:74-7, 2012
                                                                  8. Freedman J et al: Pelvic congestion syndrome: the role of interventional radiology in the treatment of chronic pelvic pain. Postgrad Med J. 86(1022):704-10, 2010
                                                                  9. Asciutto G et al: Pelvic venous incompetence: reflux patterns and treatment results. Eur J Vasc Endovasc Surg. 38(3):381-6, 2009
                                                                  10. Asciutto G et al: MR venography in the detection of pelvic venous congestion. Eur J Vasc Endovasc Surg. 36(4):491-6, 2008
                                                                  11. Creton D et al: Embolisation of symptomatic pelvic veins in women presenting with non-saphenous varicose veins of pelvic origin - three-year follow-up. Eur J Vasc Endovasc Surg. 34(1):112-7, 2007
                                                                  12. Ganeshan A et al: Chronic pelvic pain due to pelvic congestion syndrome: the role of diagnostic and interventional radiology. Cardiovasc Intervent Radiol. 30(6):1105-11, 2007
                                                                  13. Liddle AD et al: Pelvic congestion syndrome: chronic pelvic pain caused by ovarian and internal iliac varices. Phlebology. 22(3):100-4, 2007
                                                                  14. Cheong Y et al: Chronic pelvic pain: aetiology and therapy. Best Pract Res Clin Obstet Gynaecol. 20(5):695-711, 2006
                                                                  15. Kim HS et al: Embolotherapy for pelvic congestion syndrome: long-term results. J Vasc Interv Radiol. 17(2 Pt 1):289-97, 2006
                                                                  16. Koc Z et al: Association of left renal vein variations and pelvic varices in abdominal MDCT. Eur Radiol. 2006
                                                                  17. Nicholson T et al: Pelvic congestion syndrome, who should we treat and how? Tech Vasc Interv Radiol. 9(1):19-23, 2006