Chronic pelvic pain can be a perplexing problem for clinicians and it can be a frequent complaint in women of child bearing age. Pelvic congestion syndrome is one cause of chronic pelvic pain that can be diagnosed by radiologists and treated by interventional radiologists. There are many different modalities that radiologists may encounter dilated pelvic veins on, and it is important that these findings are mentioned in their reports, especially if there are notes of that patient complaining of chronic pelvic pain. There are a few different anatomic variants that are also important to look for when viewing these studies that might help determine the cause of pelvic congestion syndrome. If findings concerning for pelvic congestion syndrome are noted on imaging, interventional radiologists should become involved as there are non-invasive treatment options for these patients.
Educational Goals / Teaching Points
- Review the pathophysiology, anatomy, and clinical presentation of pelvic congestion syndrome (PCS).
- Discuss aberrant anatomy findings including a retroaortic renal vein, nutcracker phenomenon, and May-Thurner syndrome.
- Describe the imaging findings of PCS using different imaging modalities including ultrasound, CT, MRI and fluoroscopic venograms.
- Discuss the role of the interventional radiologist in managing PCS and describe the minimally invasive treatment options that are offered.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Anatomy reviewed: renal veins, ovarian veins, female pelvic veins, retroaortic left renal vein, nutcracker phenomenon, May-Thurner syndrome, outflow tracts in pelvic congestion syndrome.
Pathophysiology discussed: how female pelvic veins become congested such as from pregnancy, the aberrant anatomical variants, how each type of dilated vein causes a symptom.
Imaging findings discussed: dilation of ovarian veins, aberrant anatomy, pre and post-treatment imaging.
Imaging modalities used: US, CT, MRI, fluoroscopic venograms.
The treatment for pelvic congestion syndrome is evolving with the techniques that have been introduced by interventional radiology. Due to the prevalence of this condition among women of child bearing age, it is important for diagnostic radiologists to be familiar with the findings that are associated and understand when to involve interventional radiology. I will be discussing many aspects pelvic congestion syndrome including the pathophysiology, the anatomy, the imaging findings on multiple modalities as well as the treatment options offered by interventional radiology including ovarian vein embolization.