E2361. Pelvic Congestion Syndrome: Possibly an Under-Diagnosed Etiology of Chronic Hip Pain in Women
  1. Manasi Arora; Mayo Clinic - Jacksonville
  2. Luke Spencer Gardner; Mayo Clinic - Jacksonville
  3. Hillary Garner; Mayo Clinic - Jacksonville
  4. Jeffrey Peterson; Mayo Clinic - Jacksonville
  5. Ronnie Sebro; Mayo Clinic - Jacksonville
  6. Rupert Stanborough; Mayo Clinic - Jacksonville
Pelvic congestion syndrome (PCS) is a debilitating condition defined as chronic, dull pelvic pain in the absence of underlying pathology. The clinical presentation of PCS is non-specific, and therefore, the diagnosis greatly depends on identifying pelvic venous insufficiency (PVI) on imaging. Few studies in the literature reported chronic hip pain as the only presenting symptom of PCS. However, the potential association between refractory hip pain in women and PCS has not been well-analyzed, and through this study, we aim to answer this question.

Materials and Methods:
A retrospective review was performed for 50 women (median age=65 years (IQR:55-73) who that underwent magnetic resonance imaging (MRI) of the hip joint from September 2021 to April 2022 due to long-standing hip pain. Medical records and imaging data were evaluated. The criteria proposed by Coakley et al. were used for making the imaging diagnosis, i.e., four or more ipsilateral parauterine veins of varying caliber, at least one measuring greater than 4 mm diameter, or an ovarian vein diameter greater than 8 mm.

The imaging signs of PVI were seen in 43 (86%) out of the 50 women. The women with PVI were evaluated, and it was found that the majority presented with left-sided hip pain (n = 25, 58%) and had a history of hysterectomy/uterine fibroids (n=26, 60%). Additional imaging findings including hip osteoarthritis (OA), tendinopathy, or tendon tear were seen in 42% (n = 19), 21% (n = 9), and 14% (n = 5) of the patients, respectively. However, none of the diagnostic reports evaluated the presence of PVI. The most common clinical diagnosis made was OA (n = 14, 32%). The majority of these patients were managed conservatively using physical therapy (n = 13, 30%) and intra-articular injections (n = 13, 30%). Despite this, more than half of them (62%) demonstrated no significant clinical improvement over the study period.

In our study, although, a significant number of women (86%) with chronic hip pain met the imaging criterion of PVI, these findings although highly sensitive, are much less specific. PCS is a diagnosis based on a combination of symptoms, physical examination, and evidence of PVI. Women with chronic, refractory hip pain with signs of PVI should be considered for an undiagnosed PCS.