Role of Trans Vaginal Ultrasound and Doppler in Diagnosis of Pelvic Congestion Syndrome

Sharma, Kaveri; Bora, Manash Kumar; Varghese, Jessy; Malik, Gaurav; Kuruvilla, Robin

doi:10.7860/jcdr/2014/8106.4570

Cited by 12 publications

(7 citation statements)

References 10 publications

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“…This method helps to establish presence of varicose veins in the small pelvis by measuring the diameters, blood flow rate in the veins, and to determine preliminarily the leading pathogenetic mechanism: incompetence of the ovarian veins or venous obstruction. This method can also be used for dynamic assessment of conservative and surgical treatment of VVP [22,38,40,[67][68][69][70][71][72][73].…”

Section: Instrumental Diagnosis Of Varicose Veins Of the Pelvismentioning

confidence: 99%

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A Current View on the Problem of Varicose Veins of the Pelvis (Review)

Фомина¹,

Akhmetzyanov²,

Бредихин³

et al. 2018

Sovrem Tehnol Med

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Etiopathogenesis and diagnosis of varicose veins of the pelvis or pelvic varicose veins have been considered from the present-day perspective. Despite a high prevalence of this pathology it is still insufficiently explored.One of the main symptoms of the disease is a chronic pain in the lower abdomen lasting over six months and suffered by women of various ages. In the foreign literature, it is commonly called pelvic congestion syndrome, in the Russian literature -varicose veins of the pelvis.Varicose veins of the pelvis can arise due to aplasia or venous valve incompetence, the genetic origin of the illness is confirmed by numerous scientific investigations. The second main cause is venous obstruction. The emergence of the disease is also promoted by the specific anatomy of the venous outflow from the small pelvis: the right ovarian vein opens into the inferior vena cava, and the left ovarian vein to the left renal vein. The normal angle between the aorta and the superior mesenteric artery is about 90°, and in case of the angle reduction aorto-mesenteric compression of the renal artery takes place.One of the disease complications is thrombosis of the intrapelvic venous plexuses and the ovarian veins which occurs most commonly in the period of pregnancy or after delivery, and less rarely after various surgical interventions in the small pelvic organs.The knowledge of etiopathogenesis principles will facilitate differential diagnosis of chronic pelvic pain in patients with varicose veins of the pelvis.

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Section: Instrumental Diagnosis Of Varicose Veins Of the Pelvismentioning

confidence: 99%

“…not more than 5 mm [14,40,74], and the average diameter of the arcuate veins is 1.1±0.4 mm [74]. Veins with the diameter exceeding 5 mm are considered dilated [22,51,67,68].…”

Section: Instrumental Diagnosis Of Varicose Veins Of the Pelvismentioning

confidence: 99%

A Current View on the Problem of Varicose Veins of the Pelvis (Review)

Фомина¹,

Akhmetzyanov²,

Бредихин³

et al. 2018

Sovrem Tehnol Med

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“…Chronic pelvic pain has several differential diagnoses, including endometriosis, pelvic inflammatory disease, pelvic adhesions, ovarian pathology, and the often-overlooked PCS. 2 There are commonalities in patients with PCS that should be underlined, mainly that these patients are “mostly premenopausal, multiparous women who have complaints of CPP accompanied with dysmenorrhea, and exacerbated symptoms during and after intercourse or prolonged standing.” 3 There is no concrete, evidence-based method of diagnosis for PCS. Rather, the diagnosis is largely based on the exclusion of other causes, a physical examination revealing tenderness, and documentation of pelvic vein incompetence via imaging.…”

Section: Introductionmentioning

confidence: 99%

An Inconvenient Truth: The Added Value of Transvaginal Imaging of the Internal Iliac and Adnexal Veins for Pelvic Congestion Syndrome

Walsh

Ahern

Zahiri

et al. 2019

Journal for Vascular Ultrasound

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Pelvic congestion syndrome is a chronic condition involving varicose veins in the pelvic area, resulting in dull aching pain, pelvic heaviness, palpable varicosities, and dyspareunia. The primary diagnostic modalities, computed tomography (CT) angiography and magnetic resonance (MR) angiography, can be time-consuming, expensive, and carry the risks of diagnostic radiation (CT) and intravenous contrast (CT and MR), and may not offer dynamic vascular information (CT). Recently, an increased role for ultrasound has been proposed in the diagnosis of pelvic congestion; however, the role of transvaginal (TV) duplex ultrasound has not been thoroughly investigated. Our study aims to evaluate the utility of a TV approach in the evaluation of valvular incompetence time (VIT) in seconds of the internal iliac and adnexal veins. A waiver of consent was granted by our Institutional Review Board for this retrospective review. A cohort of 36 women undergoing ultrasound evaluation for pelvic congestion syndrome was analyzed. Transvaginal and transabdominal (TA) images were obtained with reverse Trendelenburg positioning for imaging of the internal iliac veins with Valsalva maneuver to evaluate VIT, at the same visit, and the yield of each approach was compared for the presence of VIT. The number of vessels visualized, VIT, diagnostic success, and number of abnormal vessels were recorded. Between September 2018 and February 2019, 36 women underwent both TA and TV imaging. A total of 72 (100%) internal iliac veins were visualized by TV, but only 15 (21%) by TA. Of the 72 internal iliac veins imaged, 12 (17%) were shown to have valvular incompetence by TV exam, whereas only 2 (3%) were identified by TA, both of which were identified TV. Transabdominal images, when limited, were usually due to bowel gas. Transvaginal images had a higher yield for detection of internal iliac vein VIT, suggesting that the TV approach may be more sensitive and potentially more accurate versus a TA-only protocol.

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“…This is a multidisciplinary pathology, which could be diagnosed by various specialists. Ultrasound markers of PCS include dilated pelvic veins > 6 mm, slow (< 3 cm/s) or reversed flow within ovarian veins, polycystic changes within the ovaries, dilated veins within the myometrium [2,3]. The low awareness of the disease among both doctors and patients is the main issue.…”

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confidence: 99%