Learning objectives
The purpose of this educational exhibit is to describe the role and imaging characteristics of time-resolved MR angiography (TR-MRA) in the evaluation of pelvic congestion syndrome.
Background
Pelvic congestion syndrome (PCS) is a chronic condition in women caused by pelvic varices and retrograde flow through a dilated ovarian vein with incompetent valves,
usually on the left side.
Patients typically present with chronic,
non-cyclical,
dull and aching pain in the pelvis and lower abdomen.
Some patients also have varices in vulva,
buttocks or proximal thighs.
PCS is often considered a diagnosis of exclusion.
The diagnosis of PCS is commonly missed,
which is unfortunate because PCS is a potentially treatable cause of chronic pelvic...
Findings and procedure details
Introduction and Definitions
Pelvic congestion syndrome (PCS) is a source of chronic pelvic pain in women caused by venous obstruction and retrograde flow in an ovarian vein.
PCS is considered the female equivalent of scrotal varicocele.
PCS is often misdiagnosed,
or clinicians fail to consider it in the large differential diagnosis of chronic pelvic pain.
In addition,
patients may fail to alert their healthcare provider to symptoms of mild chronic pelvic pain in the mistaken belief it is due to dysmenorrhea.
Etiology and Pathophysiology:
PCS...
Conclusion
Primary pelvic congestion syndrome (PCS),
the female counterpart of male varicocele,
is caused by incompetence of the ovarian vein,
usually on the left side and often in combination with “nutcracker-like” compression of the left renal vein.
The ovarian vein reflux leads to pelvic vein engorgement.
However,
the imaging findings must be correlated with symptoms of chronic pelvic pain to render a diagnosis of PCS.
Although non-invasive imaging techniques,
such as ultrasound,
CT and static MRI,
can be helpful in patients with suspected PCS,
they cannot...
References
Ahmed K,
Sampath R,
Khan MS.
Current trends in the diagnosis and management of renal nutcracker syndrome: a review.
Eur J Vasc Endovasc Surg 2006; 31:410-416
Ali-el-Dein B,
Osman Y,
El-Din S,
El-Diasty T,
Mansour O,
Ghoneim MA.
Anterior and posterior nutcracker syndrome: a report on 11 cases.
Transplant Proc 2003; 35:851-853
Asciutto G,
Mumme A,
Marpe B,
Köster O,
Asciutto KC,
Geier B.
MR venography in the detection of pelvic venous congestion.
Eur J Vasc Endovasc Surg 2008; 36:491-496
Belenky A,
Bartal G,
Atar...