Pelvic Congestion Syndrome (CT)

Case courtesy of our radiology website partner, RiT.
Axial CT image of the same patient at the level of the uterus shows multiple dilated veins in the pelvic cavity, indicating pelvic varices.

Pelvic Congestion Syndrome

* Multifactorial disease that may be from anatomical obstruction of ovarian veins, or secondary to other diseases such as valvular incompetence, portal hypertension.
* Dilated, tortuous and congested veins with retrograde flow through ovarian veins
* Signs and symptoms: deep, dull chronic pelvic pain, dyspareunia, dysmenorrhea, postcoital pain, varicose veins, tenderness on palpation

Imaging Findings

* Not all pelvic varices represent pelvic congestion syndrome!
* Dilated ovarian veins (normal 3-4 mm, borderline 4-8 mm, abnormal > 8 mm)
* Reflux of contrast into ovarian vein(s)
* Slow (3 cm/s) or reverse flow in ovarian veins
* Polycystic changes of ovary

References:
1. Kuligowska E, et al. Pelvic pain: overlooked and underdiagnosed gynecologic conditions. Radiographics 2005;25:3-20.
2. Karaosmanoglu D, et al. MDCT of the ovarian vein: normal anatomy and pathology. AJR 2009;192:295-299.