Pelvic Venous Congestion
Pelvic congestion is a diagnosis now infrequently made by gynecologists as a cause of chronic pelvic pain. Recent literature has been almost exclusively from radiological practice and does not always relate the diagnosis to pain. In this context the conce
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Contents 1
Pelvic Congestion: History of the Concept ......................
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Anatomy................................................................................
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Vascular Physiology ............................................................
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Ultrasound Imaging.............................................................
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Imaging Studies with Renal Transplant Donors .............
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Clinical Outcomes................................................................
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Conclusion ............................................................................
Abstract
Pelvic congestion is a diagnosis now infrequently made by gynecologists as a cause of chronic pelvic pain. Recent literature has been almost exclusively from radiological practice and does not always relate the diagnosis to pain. In this context the concept of pelvic congestion is reviewed from an historical perspective, clinical correlates identified, the pathophysiology discussed, and the place of this diagnosis in modern practice considered.
References......................................................................................
1
Pelvic Congestion: History of the Concept
W. Stones (&) School of Medicine, University of St Andrews, North Haugh Fife KY16 9TF, St Andrews, UK e-mail: [email protected]
Taylor proposed the concept of venous congestion as a cause of chronic pain in the mid-twentieth century (Taylor 1949). Congestion referred to dilatation and sluggish flow in the utero-ovarian veins, but this was not a commonly accepted concept in clinical diagnosis. Using a transcervical approach with injection of contrast medium into the myometrium, Beard and colleagues reported a comparison of radiological appearances of the pelvic veins in women with a range of clinical presentations (Beard et al. 1984). In the radiological literature, pelvic congestion was not exclusively linked to symptoms of pain, but a range of other conditions. In further work, a vasoconstrictor was used to provide evidence for a causal relationship between congestion and pain symptoms. Vasoconstriction in the pelvic veins was associated with symptom relief (Reginald et al. 1987). Pelvic congestion syndrome is probably best considered in terms of a symptom complex primarily presenting in women in the reproductive age group, whereas endometriosis (at least its symptomatic presentation) is more common in nulliparous women, and childbearing does not appear to afford protection from pelvic congestion, probably the latter condition does not have a hormone-dependent inflammatory basis. However, parity is not a risk factor as has been thought in some literature studies. Typical complaints include a shifting location of pain, deep dyspareunia and
Medical Radiology. Diagnostic Imaging, DOI: 10.1007/174_2014_1010, Springer-Verlag Berlin Heidelberg 2014
W. Stones
postcoital pain, and exacerbation of pain after prolonged standing (Beard et al. 1988). Taylor’s original observations included abnormal ovarian morphology in the presence of venous congestion
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