الفهرس 
Anatomy of the Female Genital TractOnly 14 pages are availabe for public view
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Abstract
Chronic pelvic pain is a common health problem among women and
is defined as non-cyclic pelvic pain of more than 6 months’ duration (Black
et al, 2010).
The presence of a vascular cause of pelvic pain was first mooted in
the late 19th century (Liddle and Davies, 2007).
This condition, which has become known as the pelvic congestion
syndrome (PCS), only gained widespread acceptance after Beard et al.’s
work of the 1980s, which showed 91% of women with chronic pelvic pain to
have identifiable pelvic varicosities (Liddle and Davies, 2007).
The precise etiology of pelvic congestion syndrome (PCS) remains
poorly understood but is believed to be multifactorial having mechanical,
hormonal and psychological components (Robertson and McCuaig, 2013).
Radiological imaging is essential in the assessment of PCS and is
frequently used to confirm the clinical suspicion of this condition. Noninvasive
modalities are recommended as a first-line investigation; however,
the gold standard remains selective venography (Osman et al, 2013). Findings in Pelvic Congestion Syndrome:
US and CFD: Pelvic varices (>5 mm) with slow flow. Dilated arcuate veins in myometrium. Polycystic changes in ovaries. Dilated left ovarian vein and reversed flow. Left renal vein stenosis (in patients with accompanying nutcracker syndrome). CT: Filling of ovarian veins on arterial phase images. Dilated ovarian vein and pelvic varices. Left renal vein stenosis (in patients with accompanying nutcracker
syndrome). MR imaging:
Filling of ovarian veins on MR angiography images on arterial phase
images. Pelvic varices appearing:
Signal void on T1-weighted images.
Hyperintense on gradient-echo images.
Hypointense, hyperintense, or mixed signal intensity on T2-weighted
images. Venography: Demonstration of reflux into ovarian vein. Dilatation of ovarian vein >8–10 mm. Dilated pelvic veins. Filling of contralateral pelvic varices and extrapelvic varices
(Karcaaltincaba et al, 2008).
The traditional treatment of pelvic congestion syndrome has included
both medical (analgesics, hormones) and surgical approaches (hysterectomy,
ovarian vein ligation) (Pieri et al., 2003).
Ovarian and/or internal iliac vein embolization appears to be a safe,
well-tolerated, effective treatment for PCS that has not respond to
medication (Chung and Huh, 2003).