Pelvic Congestion

Question 1

Established criteria for the (imaging) diagnosis of PCS.

Answer 1

DUS
Normal vein diameter pelvic veins: <4 mm
Reversed caudal flow in ovarian vein
Tortuous aspect of ovarian veins
Pelvic varicosities >6 mm

CT/MRI
Grade I venous reflux: early filling of left ovarian vein and/or left parauterine veins
Grade 2 venous reflux: Grade I reflux + right ovarian gonadal vein reflux, internal iliac vein reflux (left/right)
Identification of four ipsilateral pelvic veins with at least I measuring > 4 mm

Venography Ovarian vein diameter >8 mm
Venous reflux shown by (slow) proximal injection into ovarian vein with distal filling of the ovarian vein plexus
Incompetent pelvic veins defined as > 10mm in diameter
Congestion (of flow) in the ovarian, pelvic, vulvovaginal or thigh veins

Question 2

Items routinely screened in our patients suspected of pelvic congestion syndrome.

Answer 2

1. Żyła główna dolna (drożność)
2. Lewa żyła nerkowa (nutcracker)
3. Żyły jajnikowe (anatomia, poszerzenie - 6/8/10mm, przepływ wsteczny, refluks)
4. Miednica
   -żylaki (poszerzone, kręte)
   -biodrowe wewnętrzne
   - żylaki w pachwinie
   - łączność z żylakami na nodze
   - ucisk żył biodrowych
   - krążenie oboczne?

Question 3

PCS symptomy

Answer 3

pelvic pain that worsens pre-lenstrually, dyspareunia, bladder irritability and rgency, and vulva, buttock, and lower limb vari-osities. Suspicion of the syndrome is usually raised y the presence of pelvic pain and in all reported ases this symptom has been managed