Type:
Educational Exhibit
Keywords:
Vascular, Pelvis, Veins / Vena cava, MR, MR-Angiography, Diagnostic procedure, Technical aspects, Varices, Haemodynamics / Flow dynamics
Authors:
S. Wassef, A. Stolpen; Iowa City, IA/US
DOI:
10.1594/ecr2018/C-2652
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 pain.
Non-invasive imaging techniques,
such as ultrasound,
CT and MRI,
can be helpful in suggesting a diagnosis of PCS.
However,
they fail to demonstrate the direction of venous blood flow and the temporal sequence of venous opacification,
both of which are essential features of PCS and can aid in treatment planning.
Conventional angiography is considered the gold standard diagnostic imaging modality for PCS,
but TR-MRA has recently begun to supplant conventional angiography because it provides similar diagnostic information,
is noninvasive,
and does not expose patients to ionizing radiation.