Imaging Pathway for the Diagnosis and Treatment for Pelvic Congestion Syndrome

Educational Poster Background: Pelvic congestion syndrome (PCS) is a known (and underdiagnosed) cause of chronic pelvic pain in the female population. There is an increased incident in the postpartum cohort and in patients with recurrent lower limb varicose veins. Although the pathophysiology is poorly understood, pelvic venous incompetence is defined by the presence of pelvic varicoceles and reflux within the ovarian veins. The clinical presentation is often nonspecific; thus, the causes of pelvic pain such as pelvic inflammatory disease, endometriosis, adenomyosis, and uterine fibroids must be excluded before diagnosis. We describe the clinical aspects of PCS including the common presentations, examination findings, and etiology. Our imaging pathway for patients clinically suspected of PCS includes transabdominal/transvaginal ultrasound, duplex ultrasound, and magnetic resonance imaging pelvis features (with specific examples). The treatment options will be considered, with a specific focus on ovarian vein embolization (OVE). The technical considerations of OVE and the pearls and pitfalls with example cases from our tertiary center are also demonstrated. PCS can be a debilitating condition in the symptomatic patient population. The importance of correct diagnosis and treatment with OVE with a multidisciplinary approach can lead to good clinical outcomes in the vast majority of cases.

To demonstrate clinical presentation and imaging findings of pelvic congestion syndrome (PCS). To demonstrate our local imaging pathways for patients with PCS. To understand the treatment options available for PCS and specifically the work up for ovarian vein embolization, focusing on pearls and pitfalls.

Publication History

Article published online:
26 April 2021