Pelvic Congestion Syndrome (CT)

Case courtesy of our radiology website partner, RiT.
Axial CT image of a 42-year-old woman with chronic pelvic pain shows dilatation of bilateral ovarian veins (arrows).

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.