In Reply to: Case 0400_09 -- Pelvic Congestion Syndrome:The Diagnostic Value of Venography posted by Editor on April 04, 2000 at 16:55:39:
The key issue with pelvic congestion syndrome is that it is a difficult diagnosis to make on routine imaging studies, particularly if the interpreting physician is not considering it in the differential of pelvic pain. If if that specific diagnosis is being persued, abnormal venous structures may not be appreciated when the patient is in the usual position for most imaging modalities, supine. Additionally, abnormal venous structures may not be appreciated during laparoscopy, again because the patient is supine and because the gas used to insuflate the abdomen effaces the low pressure veins (often the patient is placed with the head down to keep the gas in the pelvis, making the diagnosis even more difficult!).
For these reasons, in my opinion, if there is a strong clinical suspicion of pelvic congestion, venography should be performed even if other imaging modalities are normal. I would perform venography even as the first exam if the history is compelling.