TeleFast Rad

⚠️Pelvic Congestion Syndrome⚠️
It is a cause of chronic pelvic pain due to dilated, incompetent pelvic veins—basically the pelvic version of varicose veins.

🔻☢️ Radiological Diagnosis☢️🔻

🥇 1️⃣ Catheter Venography (Gold Standard)

This is the definitive radiologic test and is usually performed when embolization is planned.

🔻Diagnostic Venographic Criteria:

✔ Ovarian vein diameter > 6 mm
✔ Reflux of contrast in the ovarian vein (especially left)
✔ Filling of dilated, tortuous pelvic venous plexus
✔ Delayed contrast clearance (venous stasis)
✔ Cross-pelvic filling of contralateral veins
✔ Opacification of v***ar, perineal, or thigh varices from pelvic veins

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🥈 2️⃣ Transvaginal Doppler Ultrasound (First-Line Imaging)

Best initial, noninvasive modality.

🧠 Key point: Demonstration of reflux is more important than size alone.

Dynamic exam (upright or semi-erect + Valsalva) improves sensitivity.
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🥉 3️⃣ MRI (Best Cross-Sectional Modality)

Great for confirming venous congestion and excluding other causes of pelvic pain (endometriosis, adenomyosis).

🔻MRI Findings Suggestive of PCS

✔ Multiple serpiginous flow voids around uterus and ovaries
✔ Dilated ovarian vein:
• Commonly > 8 mm
✔ Engorged parauterine and parametrial veins
✔ High-signal intensity slow flow on T2
✔ Enhancement of dilated veins post-contrast
✔ Varices extending to v***a or pelvic sidewall
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4️⃣ CT Scan

Less preferred (radiation, supine position reduces venous distension) but often shows PCS incidentally.

🔻CT Features

✔ Dilated ovarian vein (>8 mm often used)
✔ Multiple tortuous enhancing veins in adnexa
✔ Congested uterine/ovarian plexus
✔ Pelvic varices crossing midline

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⚠️ Important Radiology Pitfalls

🔴 Vein size alone is NOT diagnostic
Many women without symptoms have large ovarian veins.

🔴 Supine imaging underestimates reflux
Ultrasound with Valsalva is more sensitive.

🔴 Must correlate with chronic pelvic pain pattern

⚠️☢️Role of interventional radiology in PCS
Interventional radiology is basically the main character in treating Pelvic Congestion Syndrome now — both diagnosing it definitively and fixing the problem in the same sitting.
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🎯 Main Role of IR in PCS:

🥇 1️⃣ Diagnostic Confirmation

Although US/MRI suggest PCS, IR confirms it with venography:
• Selective catheterization of ovarian veins (usually left first)
• Sometimes internal iliac veins
• Demonstrates:
• Venous reflux
• Dilated tortuous pelvic plexus
• Cross-pelvic collateral flow
• Delayed emptying
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💉 2️⃣ Definitive Treatment — Pelvic Vein Embolization

This is now the treatment of choice for PCS.

🔧 What is embolized?
• Refluxing ovarian vein(s)
• ± Internal iliac vein branches (uterine, obturator, pudendal) if contributing

🔻Goal: eliminate reflux and decompress pelvic venous plexus
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☢️ Variants holding the name“Horseshoe“ rarher than the famous “ Horseshoe Kidney”..?!🤔🧲

🫁 Thorax / Lungs

🔻Horseshoe lung
• Rare congenital anomaly
• The right and left lungs are connected by a band of lung tissue (isthmus) behind the heart
• Strongly associated with scimitar syndrome

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🧠 Brain

🔻Horseshoe-shaped lateral ventricles
• Seen in agenesis of the corpus callosum
• The lateral ventricles run parallel and curve in a crescent/horseshoe configuration

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🧬 Adrenal glands

🔻Horseshoe adrenal gland
• Extremely rare fusion anomaly
• Often associated with asplenia/polysplenia syndromes and other heterotaxy abnormalities

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