Pelvic varices and ovarian varicocoele

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Pelvic varicocele occurs in about 10% of the general female population and in about half of women who have chronic pelvic pain.
Marked ovarian varices may cause a Pelvic congestion syndrome (PCT). Varicose veins in the broad ligaments may cause ill-defined pelvic pain associated with enlargement of the uterus and adnexa. Pelvic gonadal veins do not effectively move blood to the heart, and may become chronically dilated and enlarged. This may lead to a chronic condition of dull pelvic pain, pressure and heaviness.
Other symptoms include:
- Varicose veins (vulvar, buttocks, legs)
- Low backache after standing for long periods of time
- Abnormal menstrual bleeding
- Painful menstrual periods
- Ovary tenderness
- Post-coital ache Irritable bladder

Sonography :
Venous drainage of ovarian veins occurs via the ovarian plexus, which connects with the uterine plexus at the level of the broad ligament. Generally, a single ovarian vein leaves the ovarian plexus and ascends superiorly along the course of the psoas muscle and drains into the left renal vein on the left side, and into the inferior vena cava on the right side. The sonographic appearances of normal pelvic venous plexus are one or two straight tubular structures with a diameter of less than 5 mm.
Sonographic findings of pelvic congestion syndrome are dilated left ovarian vein with reversed caudal flow, multiple dilated veins around the ovary and uterus with a venous, dilated arcuate veins crossing the uterine myometrium, polycystic changes of the ovary, and variable duplex waveform during the Valsalva's maneuver.
Pelvic varices are observed with TVUS as multiple dilated veins that are >5 mm in diameter, located within the broad ligament of the uterus. The presence of circular or linear venous structures with a diameter greater than 5 mm is indicative of pelvic varicosities. Variable duplex waveform in a pelvic varicocele during the Valsalva's maneuver is an important Doppler sonographic finding for diagnosing pelvic congestion syndrome : including initial accentuation, reversed flow direction, and abrupt disappearance of flow and sometimes no change of flow pattern.

Treatment
* Vein embolization appears to be a safe, well-tolerated, effective treatment for pelvic congestion syndrome.

References :
* 1 : Kim HS, Malhotra AD, Rowe PC, Lee JM, Venbrux AC. Embolotherapy for Pelvic Congestion Syndrome: Long-term Results. J Vasc Interv Radiol. 2006 Feb;17(2):289-97.
* 2 : Park SJ, Lim JW, Ko YT, Lee DH, Yoon Y, Oh JH, Lee HK, Huh CY. Diagnosis of pelvic congestion syndrome using transabdominal and transvaginal sonography. AJR Am J Roentgenol. 2004 Mar;182(3):683-8.
* 3 : Chung MH, Huh CY. Comparison of treatments for pelvic congestion syndrome. Tohoku J Exp Med. 2003 Nov;201(3):131-8.
* 4 : Tarazov PG, Prozorovskij KV, Ryzhkov VK. Pelvic pain syndrome caused by ovarian varices. Treatment by transcatheter embolization. Acta Radiol. 1997 Nov;38(6):1023-5.
* 5 : Hodgson TJ, Reed MW, Peck RJ, Hemingway AP. Case report: the ultrasound and Doppler appearances of pelvic varices. Clin Radiol. 1991 Sep;44(3):208-9.
* 6 : Kennedy A, Hemingway A. Radiology of ovarian varices. Br J Hosp Med. 1990 Jul;44(1):38-43. Review.
* 7 . Hodson TJ, Reed MW, Peck RJ, Hemingway AP. The ultrasound and Doppler appearances of pelvic varices. Clin Radiol 1991; 44:208-209
* 8 Giacchetto C, Cotroneo GB, Marincolo F. Ovarian varicocele: ultrasonic and phlebographic evaluation. J Clin Ultrasound 1990; 18:551-555.
* 9 . Park SJ, Lim JV, Ko YT, et al. Diagnosis of pelvic congestion syndrome using transabdominal and transvaginal sonography. AJR Am J Roentgenol 2004; 182:683-688