Abstract No. 565 Pelvic congestion syndrome: a missed opportunity

Abstract

Pelvic congestion syndrome (PCS) is a common cause of pelvic pain. It is diagnosed by clinical symptoms, exclusion of other etiologies, and imaging. Given the complex nature and diagnosis of pelvic pain, we examined the ordering and referral patterns in our local population to understand how PCS is triaged and managed. After institutional board review approval, we identified female patients 18-70 years old with CTs of the abdomen and pelvis from 3/2015-3/2018 with the terms “pelvic” plus “congestion,” “varices,” or “vein dilation” included in the dictation. We excluded duplicate exams, patients status post intervention for PCS, or without PCS imaging findings. We collected data regarding demographics, clinical presentation, prior symptoms, imaging findings, ordering provider, and any follow up or interventions regarding PCS. A total of 99 patients were identified, with an average age of 47.5 years and average BMI of 19.3 (n=93) at the time of imaging. PCS findings were often incidental, as many patients received imaging due to acute abdominal or flank pain (n=22) or routine oncologic imaging (n=18). Only 72 patients had documentation of evaluation of any clinical symptom related to PCS, including pelvic pain, pelvic pressure, dyspareunia, back pain, menorrhagia, or lower extremity or vulvar varices. Fewer than half of included patients had documentation relating to the presence or absence of pelvic pain or chronic pelvic pain. The ordering department and subsequent referrals are identified in Table 1. Notably, only two patients were referred to IR, and both underwent endovascular intervention. Pelvic pain is a common cause of morbidity, and PCS may be a causative factor in a significant proportion of patients. We demonstrate that while imaging findings may be incidental, we are failing to capture and triage those patients with both imaging and clinical symptoms of PCS. Via increased awareness and outreach, IRs have the opportunity to relieve the symptoms of many patients.Table 1Ordering Provider and Referral and Follow-up LocationsOrdering (n=99)Referral (n=21)ED37-1' care162Ob/gyn317Vascular surgery25Radiology22Other413 Open table in a new tab