Pelvic Congestion Syndrome in a Postmenopausal Female.

Neha Potla,Thor S Stead,Savithri-Chandana Veluri,Jesse Dubey,Latha Ganti

doi:10.7759/cureus.17444

Abstract

This study reports the case of a 53-year-old postmenopausal woman and explores her unique experience with pelvic congestion syndrome (PCS). PCS is a relatively newly recognized entity and is still a diagnosis of exclusion. We analyze the presenting symptoms and imaging findings on CT and ultrasonography. We also examine the potential causes of this ambiguous prognosis. This case is unusual in that PCS usually presents in premenopausal rather than postmenopausal women.

Highlights

The scope of current knowledge on pelvic congestion syndrome (PCS) is sparse as it is a relatively newly recognized entity and a diagnosis of exclusion
This study reports the case of a 53-year-old postmenopausal woman and explores her unique experience with pelvic congestion syndrome (PCS)
Three speculations exist on its etiology: 1) valvular insufficiency of ovarian vein or internal iliac veins leading to stasis of blood, 2) venous outflow obstruction due to extrinsic compression of pelvic veins, and 3) vasodilatory effect of estrogen on pelvic vasculature

Summary

Introduction

The scope of current knowledge on pelvic congestion syndrome (PCS) is sparse as it is a relatively newly recognized entity and a diagnosis of exclusion. Three speculations exist on its etiology: 1) valvular insufficiency of ovarian vein or internal iliac veins leading to stasis of blood, 2) venous outflow obstruction due to extrinsic compression of pelvic veins, and 3) vasodilatory effect of estrogen on pelvic vasculature This case presentation challenges the third speculation. Her only daily prescription was duloxetine 30 mg daily for the past year for anxiety related to coronavirus disease 2019 (COVID-19) She reported that the pain worsened when engaged in daily activities such as walking, a key symptom of PCS. Her vital signs included a blood pressure of 108/67 mmHg, temperature of 98.7 °F, pulse rate of 98 beats per minute, respiratory rate of 16 breaths per minute, and oxygen saturation of 99% on room air Her physical exam was only remarkable for left-sided abdominal pain. Test Sodium (mmol/L) Potassium (mmol/L) Chloride Carbon dioxide (mmol/L) Anion gap BUN (mg/dL) Creatinine (mg/dL) Estimated GFR (MDRD) Glucose (mg/dL) Calcium (mg/dL) Ionized calcium (mg/dL) Total bilirubin (mg/dL) AST (Units/L) ALT (Units/L) Total ALP (Units/L) Total protein (g/dL) Albumin (g/dL) Lipase (Units/L) Hematology WBC (x 103/uL) RBC (x 106/uL) Hgb (g/dL) Hct (%) MCV (fL) MCH (pg) MCHC (g/dL) RDW (%) Platelet count (x 103/uL) MPV (fL) Absolute basos (auto) (x 103/uL) Nucleated RBC (%) Immature granulocytes (x 103/uL) Neutrophils (x 103/uL) Lymphocytes (x 103/uL) Monocytes (x 103/uL) Eosinophils (x 103/uL) Nucleated RBCs (x 103/uL)

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Disclosures