The diagnosis of Pelvic Congestion Syndrome (PCS) is difficult because chronic pelvic pain can have multiple causes and most symptoms of PCS are shared with other common pelvic disorders including:
- Endometriosis
- Uterine fibroids
- Uterine prolapse
The diagnosis of PCS is made using several imaging tests which can include:
Ultrasound: This is the first test of choice and is useful for overall evaluation of the pelvis. It can assess the uterus and other organs in the pelvis and may diagnose other causes of pelvic pain such as fibroids. The procedure is painless and takes about 30 minutes. It is usually the first test of choice and is cheap and effective.
CT Scan: CT scan is frequently used in the diagnosis of Pelvic Congestion Syndrome. It can look at the entire anatomy of the lower pelvis and identify varicosity of the pelvic veins. There is some radiation exposure and not a recommended test in pregnant females.
MRI: MRI is a very useful test in the diagnosis of Pelvic Congestion Syndrome. It does not use radiation or contrast dye and is a painless non-invasive test and can evaluate for the presence of endometriosis, fibroids and pelvic varices.
Venogram: This invasive test involves injecting a special dye directly into the veins of the pelvis and obtaining X rays. A venogram is considered the 'gold standard' of testing for pelvic congestion syndrome. There is some radiation exposure and the risk of allergy to the dye is ever present.
Some women may undergo laparoscopic (surgical) evaluation to evaluate chronic pelvic pain but the diagnosis of PCS can be missed in more than 80% of patients during laparoscopy.
