|
|
Fig. 1. Selective injection of the left gonadal vein demonstrates marked insufficiency with filling of cross pelvic collaterals.
Case Reference No. CC-0998-03 This 36-year-old female presented with a long history of pelvic pain and "fullness" worsened by walking, prolonged standing and sexual intercourse. Initial evaluation by intravenous pyelogram and CT scan of the abdomen/pelvis demonstrated only a small intraparenchymal calcification in the left kidney. Further evaluation with transvaginal ultrasound demonstrated increased flow velocities through dilated left pelvic veins. |
Fig. 2. After placement of multiple coils a small collateral is still identified on selective injection.
Fig. 3. After placement of the final coil, selective injection of the left renal vein during valsalva demonstrates no reflux. | |
The patient was referred to interventional radiology to evaluate for ovarian vein incompetence and possible treatment. The left gonadal vein was selected using a renal double curve catheter. The left gonadal venogram demonstrated an enlarged gonadal vein (8mm diameter) refluxing to the level of the left ovarian veins, with cross filling into the right ovarian veins. Superselective catheterization of the left gonadal vein to the level of the ovarian venous varix was performed and multiple 5x8 embolization coils were deployed. Repeat venography demonstrated complete occlusion of the left gonadal vein from the varix to the renal vein. Extensive search for the right gonadal vein was unsuccessful. The patient reported relief of symptoms 1 week after embolization. Questions: 1) What criteria do you use to diagnose and treat pelvic congestion syndrome? 2) Would you continue to search for the right ovarian vein? 3) When is surgery indicated to treat pelvic congestion syndrome? 4) How would you follow up this patient? Related case | ||
 |
 |
 |
