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:
I will insist on performing a venogram regardless of findings at otehr imaging or laparoscopy, and a significnat number of women will have abnomral venograms. If the cross-sectional imaging or laparoscopy shows an abnomrality, it still doesn't make the diagnosis - because you have to see the abnomral physiology (reversed flow).
On the other hand, there was an article reviewing autopsy evaluation of the ovarian veins in Acta Radiologica many years ago, and dilation of the ovarian veins to the point where the valves no longer function (at least in an explanted vein segment) was seen to be pretty common, especially in multiparous women.
This suggests that there may be a significant number of false positive venograms. I therefore want all (or almost all) of my patients to have laparoscopy first to exclude endometriosis, PID, etc. as causes of the pain. This way my venogram patients are enriched for true congestion and the proportion of patients who respond well to embolization should be increased (Bayes theorem). It also smooths relations with the gynecologists, since they get to do the scope first.
PCS has a bad rap in the gyn community for historical reasons. That is why I prefer to refer to it as Ovarian Vein Syndrome. I find gynecologists more receptive to discussion with the change in terminology. Once they see that this is an area where we can help them with a very difficult portion of their patient population, it tends to make relationships about other entities and procedures a bit easier.