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Ultrasound
Diagnosis
Vascular
Chest and Abdomen
Reproductive
Pelvic Congestion
Pelvic Congestion
Melanie Caserta, MD; Corinne Deurdulian, MD
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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 vulvar and lower extremity varicosities
          • First 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

        IMAGING

        • General Features

          • Ultrasonographic Findings

            • CT Findings

              • MR Findings

                • Angiographic Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Staging, Grading, & Classification

                          • 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. Rane N et al: Pelvic congestion syndrome. Curr Probl Diagn Radiol. 42(4):135-40, 2013
                                    4. Ball E et al: Does pelvic venous congestion syndrome exist and can it be treated? Acta Obstet Gynecol Scand. 91(5):525-8, 2012
                                    5. Kies DD et al: Pelvic congestion syndrome: a review of current diagnostic and minimally invasive treatment modalities. Phlebology. 27 Suppl 1:52-7, 2012
                                    6. Smith PC: The outcome of treatment for pelvic congestion syndrome. Phlebology. 27 Suppl 1:74-7, 2012
                                    7. 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
                                    8. Asciutto G et al: Pelvic venous incompetence: reflux patterns and treatment results. Eur J Vasc Endovasc Surg. 38(3):381-6, 2009
                                    9. Asciutto G et al: MR venography in the detection of pelvic venous congestion. Eur J Vasc Endovasc Surg. 36(4):491-6, 2008
                                    10. 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
                                    11. 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
                                    12. Koc Z et al: Association of left renal vein variations and pelvic varices in abdominal MDCT. Eur Radiol. 17(5):1267-74, 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. Nicholson T et al: Pelvic congestion syndrome, who should we treat and how? Tech Vasc Interv Radiol. 9(1):19-23, 2006
                                    17. Fleischer AC: Recent advances in the sonographic assessment of vascularity and blood flow in gynecologic conditions. Am J Obstet Gynecol. 193(1):294-301, 2005
                                    18. Park SJ et al: Diagnosis of pelvic congestion syndrome using transabdominal and transvaginal sonography. AJR Am J Roentgenol. 182(3):683-8, 2004
                                    19. Polat P et al: Color Doppler US in the evaluation of uterine vascular abnormalities. Radiographics. 22(1):47-53, 2002
                                    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 vulvar and lower extremity varicosities
                                            • First 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

                                          IMAGING

                                          • General Features

                                            • Ultrasonographic Findings

                                              • CT Findings

                                                • MR Findings

                                                  • Angiographic Findings

                                                    • Imaging Recommendations

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          • Staging, Grading, & Classification

                                                            • 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. Rane N et al: Pelvic congestion syndrome. Curr Probl Diagn Radiol. 42(4):135-40, 2013
                                                                      4. Ball E et al: Does pelvic venous congestion syndrome exist and can it be treated? Acta Obstet Gynecol Scand. 91(5):525-8, 2012
                                                                      5. Kies DD et al: Pelvic congestion syndrome: a review of current diagnostic and minimally invasive treatment modalities. Phlebology. 27 Suppl 1:52-7, 2012
                                                                      6. Smith PC: The outcome of treatment for pelvic congestion syndrome. Phlebology. 27 Suppl 1:74-7, 2012
                                                                      7. 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
                                                                      8. Asciutto G et al: Pelvic venous incompetence: reflux patterns and treatment results. Eur J Vasc Endovasc Surg. 38(3):381-6, 2009
                                                                      9. Asciutto G et al: MR venography in the detection of pelvic venous congestion. Eur J Vasc Endovasc Surg. 36(4):491-6, 2008
                                                                      10. 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
                                                                      11. 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
                                                                      12. Koc Z et al: Association of left renal vein variations and pelvic varices in abdominal MDCT. Eur Radiol. 17(5):1267-74, 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. Nicholson T et al: Pelvic congestion syndrome, who should we treat and how? Tech Vasc Interv Radiol. 9(1):19-23, 2006
                                                                      17. Fleischer AC: Recent advances in the sonographic assessment of vascularity and blood flow in gynecologic conditions. Am J Obstet Gynecol. 193(1):294-301, 2005
                                                                      18. Park SJ et al: Diagnosis of pelvic congestion syndrome using transabdominal and transvaginal sonography. AJR Am J Roentgenol. 182(3):683-8, 2004
                                                                      19. Polat P et al: Color Doppler US in the evaluation of uterine vascular abnormalities. Radiographics. 22(1):47-53, 2002