From the Guidelines
The appropriate workup for Pelvic Congestion Syndrome (PCS) should start with a detailed medical history and physical examination, followed by transvaginal ultrasound with Doppler studies to evaluate pelvic blood flow and identify dilated ovarian veins, as recommended by recent guidelines 1. The workup for PCS is crucial in diagnosing this condition, which presents with nonspecific symptoms like chronic pelvic pain.
- A comprehensive approach is necessary, including:
- Transvaginal ultrasound with Doppler studies to evaluate pelvic blood flow and identify dilated ovarian veins
- Magnetic resonance imaging (MRI) or computed tomography (CT) with contrast to better visualize the pelvic venous system if ultrasound findings suggest pelvic congestion
- Venography as the gold standard for definitive diagnosis, allowing direct visualization of venous reflux and dilated pelvic veins
- Laparoscopy to exclude other causes of chronic pelvic pain and potentially reveal visible varicosities
- Laboratory tests, such as complete blood count, urinalysis, and tests for sexually transmitted infections, should be performed to rule out other causes of pelvic pain 1.
- Psychological assessment may be beneficial, as chronic pain often has psychological components. The recent study by 1 provides the most up-to-date guidance on the workup for PCS, emphasizing the importance of a comprehensive approach to diagnose this condition accurately.
- The study highlights the role of imaging modalities, such as ultrasound and MRI, in evaluating pelvic blood flow and identifying dilated ovarian veins.
- It also emphasizes the importance of excluding other causes of chronic pelvic pain through laparoscopy and laboratory tests. By following this comprehensive workup, healthcare providers can accurately diagnose PCS and develop an effective treatment plan to improve patient outcomes, reducing morbidity, mortality, and enhancing quality of life.
From the Research
Diagnosis of Pelvic Congestion Syndrome (PCS)
The diagnosis of PCS is difficult to make, but it should remain on the differential for chronic pelvic pain 2. The following steps can be taken to diagnose PCS:
- Non-invasive imaging such as ultrasound, CT, and MRI are essential in the diagnosis and exclusion of other conditions that cause chronic pelvic pain, as well as in the definitive diagnosis of PVCS 3
- Trans-catheter venography remains the gold standard modality for the definitive diagnosis and is undertaken as an immediate precursor to ovarian vein embolization (OVE) 3
- Magnetic resonance imaging and computed tomographic venography are usually used in the diagnosis of this condition, and criteria have been established to identify pelvic varices 4
- Ovarian vein venography demonstrating reflux to the ovaries and often into the thigh with erect positioning and valsalva can also be used to confirm the diagnosis 5
Treatment Options for PCS
The treatment options for PCS include:
- Conservative management strategies such as nonsteroidal anti-inflammatory drugs (NSAIDs), ergot alkaloid derivatives, hormonal agents, venoprotective agents, and compression therapy 6
- Embolization of pelvic and ovarian veins, which has a reported technical success rate of 96-100%, low complication rates, and long-term symptomatic relief in between 70-90% of cases 3, 4
- Surgical management such as bilateral ovarian vein ligation and excision or ligation of as many collaterals as possible, which can be performed using minimally invasive techniques 5
- Endovascular treatment with interventional radiology, which has a high success rate and low occurrence of complications 2