Case challenge · Imaging / Gynecology / Interventional · teaching

Pelvic Congestion Syndrome (PCS) Imaging · case challenge

Given a case, work through the care pathway step by step; the tool checks each choice and scores you. Decisions and basis are taken from this site's reviewed care pathways.

← View the full flowchartBased on AJR / Coakley

Case #1Imaging / Gynecology / Interventional

📋 Case data

Chronic pelvic pain · venous insufficiencySuspected secondary obstruction (nutcracker/May-Thurner/mass)

Data is taken from this pathway's reviewed node text. Work through the pathway step by step.

Step 1 / 1 · Chronic pelvic pain · venous insufficiency

Chronic pelvic pain — pelvic venous insufficiency signs?

💡 PCS/pelvic venous insufficiency = ovarian/pelvic vein reflux → pelvic varices, chronic pelvic pain (worse with prolonged standing/after intercourse; dull pain/dysuria/dyspareunia, vulvar/leg varices). TVUS + Doppler preferred (dynamic): ovarian vein >6 mm, parametrial/periovarian veins >4 mm, reflux/slow flow ≤3 cm/s, dilated arcuate veins crossing the myometrium; worse with Valsalva. Note supine position underplays varices and risks missing them; a normal scan does not exclude it; many with varices are asymptomatic.

For teaching. Decisions and their basis are taken from this site's reviewed care pathways; for licensed clinicians/trainees, this does not replace clinical judgment or local protocols.