Pelvic congestion syndrome initially detected by contrast enhanced F 18 FDG PET/CT

Pelvic congestion syndrome (PCS) is said to occur as a result of retrograde flow in an incompetent ovarian vein. Ovarian vein incompetence is seen in approximately 10% of women, and up to 60% with this abnormality can develop PCS. The etiology of PCS is poorly understood and is likely to be multifactorial. Absence of ovarian vein valves is an important factor in its development. The causes of ovarian varicoceles are multifactorial, involving both mechanical and hormonal factors. Dilatation of the ovarian veins can result in vascular incompetence and retrograde blood flow. On either CT or magnetic resonance (MR) imaging studies, pelvic varices in PCS appear as dilated, tortuous, enhancing tubular structures near the ovaries and uterus. In addition, the extension of varices to the broad ligament and paravaginal venous plexus can be appreciated. With CT, the tubular nature of these structures and the pattern of enhancement after intravenous contrast medium administration distinguish them from lymphadenopathy or adnexal masses. Unlike such masses, pelvic varices appear isodense with other veins after contrast enhancement. Contrast enhanced CT data as part of the combined PET/CT examination provide additional information when compared with non enhanced PET/CT. Because CT data supply the anatomic background for PET, the most important benefit relates to more precise anatomic localization of pathology by differentiation of the lesion from its surrounding structures. By supporting lesion detection and characterization, CT contrast agents can be of additional value in F 18 FDG non avid disease. As in the presented case, careful review of CT images in contrast enhanced PET/CT enables the detection of F 18 FDG non avid disease such as PCS. As contrast enhanced F 18 FDG PET/CT had been performed frequently, being familiar with the findings of PCS on the contrast enhanced CT images would have been helpful for the nuclear medicine physicians