Diagnostic workup
Different methods can be applied to establish the diagnosis of PCS. However, it is important to exclude other potential causes of CPP such as endometriosis, fibroids or pelvic inflammatory disease.
Ultrasound: Widely available non-invasive imaging modality to visualize the pelvic venous plexus and examination of blood flow in an upright or standing position to avoid decompression of the veins.
Venography: Catheter-directed diagnostic gold standard for PCS visualizing veins and identifi cation of incompetence, congestions and retrograde filling when PCS is suspected and noninvasive imaging is inconclusive. Enables direct
therapeutic intervention (embolization, sclerotherapy).
CT and MRI: Provide complete examination of pelvic anatomy and better imaging with spatial resolution, but do not allow for therapeutic intervention. Specificity is considered low, but can identify other causes of CPP or coexisting pathologies.
Laparoscopy: Performed as part of CPP investigation for detection of endometriosis or adhesions. Less established for PCS diagnosis. Performed in supine position, thereby overlooking pelvic varicosities.
Abbreviations: CPP: Chronic pelvic pain // CT: Computer tomography // MRI: Magnetic resonance imaging // PCS: Pelvic congestion syndrome