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What is the significance of ovarian vein reflux detected by computed tomography in patients with pelvic pain?

Published:November 27, 2008DOI:https://doi.org/10.1016/j.clinimag.2008.09.011

      Abstract

      Chronic pelvic pain (CPP) is a common gynecological complaint. CPP is nonmenstrual pain localized in the anatomic pelvis of at least 6 months' duration without any identifiable organic cause that is severe enough to cause functional disability and require treatment. Pelvic congestion syndrome (PCS) is a poorly understood disorder and often overlooked cause of pelvic pain. Ovarian vein reflux (OVR) and pelvic varicosities are a cause of PCS. On the other hand, OVR can be seen in asymptomatic women, typically parous. OVR has a characteristic appearance at enhanced computed tomography (CT). Contrast medium retrogradely fills the ovarian veins and parauterine veins during the arterial phase after intravenous contrast administration. CT is not the ideal modality to evaluate all the causes of pelvic pain, but CT is a commonly used diagnostic modality to screen patient who presents with abdominal and pelvic pain. CT can demonstrate abnormal ovarian venous flow as well as tortuous and dilated ovarian and pelvic veins. Ovarian vein reflux is important to recognize and when correlated with patient clinical presentation may help in the diagnosis of PCS.

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      References

        • Collett BJ
        • Cordle CJ
        • Stewart CR
        • Jagger C
        A comparative study of women with chronic pelvic pain, chronic nonpelvic pain and those with no history of pain attending general practitioners.
        Br J Obstet Gynaecol. 1988; 105: 87-92
        • Beard RW
        • Reginald PW
        • Wadsworth J
        Clinical features of women with chronic lower abdominal pain and pelvic congestion.
        Br J Obstet Gynaecol. 1988; 95: 153-161
        • Howard FM
        The role of laparoscopy in chronic pelvic pain: promise and pitfalls.
        Obstet Gynecol Surv. 1993; 48: 357-387
        • Hobbs JT
        The pelvic congestion syndrome.
        Br J Hosp Med. 1990; 43: 200-206
        • Cordts PR
        • et al.
        Pelvic congestion syndrome: early clinical results after transcatheter ovarian vein embolization.
        J Vasc Surg. 1998; 28: 862-868
        • Beard RW
        • et al.
        Diagnosis of pelvic varicosities in women with chronic pelvic pain.
        Lancet. 1984; 2: 946-949
        • Kennedy A
        • Hemingway A
        Radiology of ovarian varices.
        Br J Hosp Med. 1990; 44: 38-43
        • Hodgkinson CP
        Physiology of the ovarian veins during pregnancy.
        Obstet Gynecol. 1953; 1: 26-37
        • Giacchetto C
        • et al.
        Ovarian varicocele: ultrasonic and phlebographic evaluation.
        J Clin Ultrasound. 1990; 18: 551-555
        • Ahlberg NE
        • Bartley OB
        • Chidekel N
        Right and left gonadal veins: an anatomical and statistical study.
        Acta Radiol Diagn. 1966; 4: 593-601
        • Rozenblit AM
        • et al.
        Incompetent and dilated ovarian veins: a common CT finding in asymptomatic parous women.
        AJR Am J Roentgenol. 2001; 176: 119-122
        • Capasso P
        • et al.
        Treatment of symptomatic pelvic varices by ovarian vein embolization.
        Cardiovasc Intervent Radiol. 1997; 20: 107-111
        • Nascimento AB
        • Mitchell DG
        • Holland G
        Ovarian veins: magnetic resonance imaging findings in an asymptomatic population.
        J Magn Reson Imaging. 2002; 15: 551-556
        • Reginald PW
        • et al.
        Intravenous dihydroergotamine to relieve pelvic congestion with pain in young women.
        Lancet. 1987; 2: 351-353
        • Coakley FV
        • Varghese SL
        • Hricak H
        CT and MRI of pelvic varices in women.
        J Comput Assist Tomogr. 1999; 23: 429-434
        • Reiter RC
        A profile of women with chronic pelvic pain.
        Clin Obstet Gynecol. 1990; 33: 130-136
        • Mathis BV
        • et al.
        Pelvic congestion syndrome: a new approach to an unusual problem.
        Am Surg. 1995; 61: 1016-1018
        • Hiromura T
        • et al.
        Reflux in the left ovarian vein: analysis of MDCT findings in asymptomatic women.
        AJR Am J Roentgenol. 2004; 183: 1411-1415
        • Giacchetto C
        • et al.
        Radiologic anatomy of the genital venous system in female patients with variocele.
        Surg Gynecol Obstet. 1989; 169: 403-407
        • Adams J
        • et al.
        Uterine size and endometrial thickness and the significance of cystic ovaries in women with pelvic pain due to congestion.
        Br J Obstet Gynaecol. 1990; 97: 583-587
        • Kido A
        • et al.
        Diffusely enlarged uterus: evaluation with MR imaging.
        Radiographics. 2003; 23: 1423-1439
        • McKeown BJ
        • Rankin SC
        Aortocaval fistulae presenting with renal failure: CT diagnosis.
        Clin Radiol. 1994; 49: 570-572
        • McWilliams RG
        • Lindsay KA
        • Chalmers AG
        Case report: the demonstration of aortocaval fistulae by helical computed tomography.
        Br J Radiol. 1995; 68: 653-656
        • Middleton WD
        • Smith DF
        • Foley WD
        CT detection of aortocaval fistula.
        J Comput Assist Tomogr. 1987; 11: 344-347
        • Desimpelaere JH
        • et al.
        Pelvic congestion syndrome: demonstration and diagnosis by helical CT.
        Abdom Imaging. 1999; 24: 100-102
        • Kaur H
        • et al.
        Patterns of uterine enhancement with helical CT.
        Eur J Radiol. 1998; 28: 250-255
        • Gupta A
        • McCarthy S
        Pelvic varices as a cause for pelvic pain: MRI appearance.
        Magn Reson Imaging. 1994; 12: 679-681