Ovarian varicosity

Ovarian varicosities are more frequent after pregnancy [10] due to hemodynamic and physiologic factors which result in pelvic venous hypertension during pregnancy. The capacity of the ovarian veins... 

The association between varicose veins in the pelvis and pelvic pain in women has been known since the description of tubo-ovarian varicocele by Richet in 1857 [1]. However, it was not until 1976 that the phrase pelvic congestion syndrome was coined by Hobbs [2] to describe a syndrome of chronic pelvic pain and heaviness due to pelvic varicosities. The pelvic varicosities are almost always secondary to reversed flow in the ovarian vein, in essence a female... 

Fig. 11.1. Pelvic congestion syndrome. Selective injection of the left ovarian vein reveals retrograde flow in a dilated left ovarian vein and results in opaciflcation of an extensive network of pelvic varicosities...

Isolated cases of laparoscopic ovarian vein ligation have been reported [32] however, there are no large series published to date. Non-embolic interventional treatments such as venous stenting and surgical bypass have been reported in small numbers of patients when the varicosities are secondary to venous obstruction [33]. 

The same multipurpose shape catheter is then directed into the right ovarian vein. A right ovarian venogram and, if needed, embolization are performed in the same fashion as described for the left. If the ovarian venograms are negative, then bilateral internal iliac venograms are performed as rarely isolated pudendal vein reflux will cause symptomatic pelvic varicosities (Figs. 11.7a,b). We do not routinely study the internal iliac veins if ovarian vein reflux is found however, other interventionists do this routinely [34]. 

Fig. 11.8. Left ovarian venogram via femoral route demonstrating dilated ovarian vein and paraovarian varicosities which drain into the left internal iliac venous system...

Fig. 11.10a,b. Labial varicosities, a Left ovarian vein injection. There are multiple pelvic sidewall varicosities and faint opacification of labial varices. Very delayed images are often required, b Left labial venogram using butterfly needle... 

Rundqvist F,Sandhold IE,et al. (1984) Treatment of pelvic varicosities causing lower abdominal pain with extraperi-toneal resection of the left ovarian vein. Ann Chir Gynaecol 2 946-951... 

Incompetent and dilated ovarian veins are frequently seen on CT in asymptomatic parous women (Fig. 17.11) [31]. Congenital or acquired vascular malformations of the uterus or parametria present also as vascular lesions. Contrast-enhanced CT or MRI may aid in the differentiation by the early enhancement of arteriovenous malformations in contrast to a more delayed enhancement in varicosities [32]. Adnexal masses with torsion or rare uterine tumors, especially choriocarcinomas may also be surrounded by thick, tortuous, well-enhanced vessels. The clinical background and imaging findings of an adnexal or uterine mass aid in the differential diagnosis. 

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