Imaging Pearls ❯ Vascular ❯ Pelvic Congestion Syndrome
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- “Pelvic congestion syndrome is one of many causes of chronic pelvic pain. It is thought to arise from ovarian and pelvic venous incompetence. Findings from various noninvasive imaging studies, such as Doppler ultrasound and MRI, in association with the clinical symptoms are critical in establishing the diagnosis.”
Pelvic venous insufficiency: imaging diagnosis, treatment approaches, and therapeutic issues.
Knuttinen MG
AJR Am J Roentgenol. 2015 Feb;204(2):448-58 - “Pelvic venous congestion is a commonly overlooked condition that can be severely painful and debilitating for many women. The term “pelvic congestion syndrome” specifically refers to the condition first described by Louis Alfred Richet in 1857 and characterized by chronic, dull pelvic pain, pressure, and heaviness that persist for more than 6 months with no other cause . These symptoms are thought to be attributable to dilated, tortuous, and congested veins within the pelvis.“
Pelvic venous insufficiency: imaging diagnosis, treatment approaches, and therapeutic issues.
Knuttinen MG
AJR Am J Roentgenol. 2015 Feb;204(2):448-58 - “Dilated pelvic veins are more commonly seen on the left, where the left ovarian vein drains into the left renal vein before reaching the inferior vena cava, whereas the right ovarian vein drains directly into the inferior vena cava. In addition, venous outflow obstruction from anatomic variants, such as compression of the left renal vein by the superior mesenteric artery (nutcracker syndrome) may result in engorgement of the left ovarian vein. Portal hypertension and acquired inferior vena cava syndrome may be related to the development of secondary pelvic venous congestion.”
Pelvic venous insufficiency: imaging diagnosis, treatment approaches, and therapeutic issues.
Knuttinen MG
AJR Am J Roentgenol. 2015 Feb;204(2):448-58 - “Patients with PVI are typically of child-bearing age and multiparous. Women often present with unilateral or bilateral lower abdominal and pelvic pain, which is generally chronic and dull, but acute and severe pain may also occur. The pain, described as heaviness and fullness in the lower pelvis, vulvar region, and thighs, is exacerbated during menses and may be associated with dyspareunia. Patients may present with atypical nonsaphenous pudendal, vulvar, and perilabial varicosities.”
Pelvic venous insufficiency: imaging diagnosis, treatment approaches, and therapeutic issues.
Knuttinen MG
AJR Am J Roentgenol. 2015 Feb;204(2):448-58 - “The diagnostic criteria for MRI and CT proposed by Coakley et al. consist of at least four ipsilateral parauterine veins of varying caliber, at least one measuring more than 4 mm in diameter, or an ovarian vein diameter greater than 8 mm.”
Pelvic venous insufficiency: imaging diagnosis, treatment approaches, and therapeutic issues.
Knuttinen MG
AJR Am J Roentgenol. 2015 Feb;204(2):448-58 - “PVI is difficult to diagnose in many women. Its identification is based on the presence of typical symptoms and imaging findings with various diagnostic modalities and parameters. The diagnostic and therapeutic approach to PVI must be individually tailored and must take into account the severity of symptoms. Multiple treatment approaches, varying from medical therapies to aggressive surgical options, have been used in the past. More recently, there have been encouraging technical and clinical success rates for selective endovascular embolization of incompetent veins.”
Pelvic venous insufficiency: imaging diagnosis, treatment approaches, and therapeutic issues.
Knuttinen MG
AJR Am J Roentgenol. 2015 Feb;204(2):448-58