Varicose veins of the pelvis

Although the etiology of pelvic congestion syndrome is unclear, it appears that gross dilatation, valve incompetence, and reflux of the ovarian veins may be causal. Anatomic and/or hormonal factors may lead to insufficiency of the ovarian and/or internal iliac veins, resulting in peri-ovarian pelvic varicosities. Such tubo-ovarian varicoceles may be the female equivalent of testicular varicoceles.

The ultrasound diagnosis is based on a subjective impression of excessive venous channels in a patient with dull and chronic pelvic pain made worse when standing. CT scans have also been used to detect these varicosities, but an ultrasound diagnosis is usually sufficient. The objective criteria include dilated ovarian veins greater than 4 mm in diameter, dilated and tortuous arcuate veins communicating with pelvic varicose veins, and retrograde venous flow, particularly in the left ovarian vein.