Pelvic Venography Research Articles

The pelvic pain syndrome.

Physicians are beginning more and more to understand pelvic pain syndrome (PPS). Transuterine pelvic venography shows that some women who suffer from chronic pelvic pain have moderate or severe congestion. On the other hand, laparoscopy indicates that some cases have no physical abnormalities. A psychological component is frequently involved, but automatically referring a woman with PPS to a psychiatrist is unproductive. Instead, physicians should involve a psychologist based at a gynecologic clinic, especially in the case of women with a history of sex abuse with a high somatization score. In the case of women who suffer from PPS but clearly show no apparent physical causes, physicians should not investigate any further, but instead reassure them. Reassurance usually results in alleviation of pain within 6 months. PPS only strikes premenopausal women, suggesting that ovarian activity may also be involved. Thus, treating women with hormones to suppress ovulation benefits some women. The medical community still does not know whether longterm treatment with gonadotropin-releasing hormone analogues and hormone replacement effectively eliminates pelvic pain. If the above treatments do not successfully treat PPS, physicians can perform a hysterectomy and bilateral oophorectomy and prescribe sufficient hormone replacement therapy to remove heretofore undetected disease (e.g., ovarian cysts, adenomyosis, and fibroids) in 33% of cases of idiopathic PPS and alleviate pelvic pain in 66% of such cases.

Pelvic pain and pelvic venous congestion

AbstractMany women undergo laparoscopy for the investigation of chronic pelvic pain with negative results. Pelvic venography has facilitated the identification of pelvic venous congestion which is an important cause of otherwise unexplained pelvic pain. The use of ultrasound has indicated a possible causal relationship with ovarian dysfunction. Psychological studies have been limited by methodological problems but have indicated differences which might account for perception of physiological sensation as painful, and have pointed to antecedent factors such as child sexual abuse. Pelvic pain with venous congestion responds well to treatment by ovarian suppression with medroxyprogesterone acetate and the duration of benefit is enhanced by concurrent psychotherapy.

A randomized controlled trial of medroxyprogesterone acetate and psychotherapy for the treatment of pelvic congestion

The value of medroxyprogesterone acetate (MPA) and of psychotherapy in the treatment of lower abdominal pain due to pelvic congestion was assessed in a randomized controlled trial. Eighty-four women with abnormal pelvic venography were assigned to one of four treatment groups: MPA alone, MPA plus psychotherapy, placebo alone, and placebo plus psychotherapy. Women were treated for 4 months and thereafter followed up regularly for 9 months with pain assessments, pelvic ultrasound scanning, and hormone measurements. During treatment, MPA showed a significant benefit in terms of a reduction in visual analogue scale pain score, with 73% of women reporting at least 50% improvement compared with 33% of those treated with placebo. At 9 months after the end of therapy there was no overall significant effect of MPA or psychotherapy, but there was an interaction between MPA and psychotherapy, with 71% of the women in this group showing a greater than or equal to 50% reduction in pain score. Therapy with MPA is a useful first-line therapy for women with pain associated with demonstrable pelvic congestion.

Intravenous Dihydroergotamine to Relieve Pelvic Congestion with Pain in Young Women

The selective venoconstrictor dihydroergotamine (DHE) was given intravenously to 12 women with evidence of pelvic congestion. In 6 the effect of the drug on pelvic veins was observed by pelvic venography. After DHE there was a mean reduction of 35% in the diameter of the pelvic veins measured and the contrast medium cleared rapidly, with a visible reduction in pelvic congestion. In the other 6 women DHE was given during an acute attack of pelvic pain. The effect of the drug on pain relief was assessed by a single-blind crossover trial with intravenous saline as the placebo and by a visual analogue scale to assess the intensity of pain. Pain was significantly lower post-DHE 4 and 8 h and 2 and 4 days after treatment than after placebo. The results confirm a close association between demonstrable pelvic congestion and pelvic pain.

Clinical features of women with chronic lower abdominal pain and pelvic congestion.

The clinical features of 35 women with pelvic pain and demonstrable congestion on pelvic venography have been characterized by comparing their symptoms and signs with those of 22 women with pelvic pain due to classical pathology. Women with pelvic pain and congestion had a mean age of 32.4 years, were more often multiparous and had had symptoms for 6 months to 20 years. The pain was dull and aching with sharp exacerbations. In individual women it commonly occurred on one side of the abdomen but unlike the pain due to 'classical pathology', it could occur on the other side. The pain was exacerbated by postural changes, and walking. Congestive dysmenorrhoea, deep dyspareunia and postcoital ache were common findings in women with pelvic congestion and 60% had evidence of significant emotional disturbance. The combination of tenderness on abdominal palpation over the ovarian point and a history of postcoital ache was 94% sensitive and 77% specific for discriminating pelvic congestion from other causes of pelvic pain.

INTRAVENOUS DIHYDROERGOTAMINE TO RELIEVE PELVIC CONGESTION WITH PAIN IN YOUNG WOMEN

The selective venoconstrictor dihydroergotamine (DHE) was given intravenously to 12 women with evidence of pelvic congestion. In 6 the effect of the drug on pelvic veins was observed by pelvic venography. After DHE there was a mean reduction of 35% in the diameter of the pelvic veins measured and the contrast medium cleared rapidly, with a visible reduction in pelvic congestion. In the other 6 women DHE was given during an acute attack of pelvic pain. The effect of the drug on pain relief was assessed by a single-blind crossover trial with intravenous saline as the placebo and by a visual analogue scale to assess the intensity of pain. Pain was significantly lower post-DHE 4 and 8 h and 2 and 4 days after treatment than after placebo. The results confirm a close association between demonstrable pelvic congestion and pelvic pain.

Postpartum cardiomyopathy and acute myocarditis

Postpartum cardiomyopathy may be defined as congestive cardiac failure due to primary myocardial disease occurring in the first 5 months after delivery. Various terms such as postpartum heart disease,’ peripartum cardiomyopathy,2 idiopathic myocardiopathy of the puerperium,3 pregnancy cardiomyopathy,4 and peripartal cardiomyopathy> have been applied in the literature to delimit this entity. Clinical presentation is characterized by insidious left-sided cardiac failure, which is invariably followed by varying intervals by symptoms of right ventricular failure. We report a case of postpartum cardiomyopathy whose initial clinical presentation consisted of repeated pulmonary thromboembolism and histologic findings of acute inflammatory myocarditis in myocardial biopsy. A 24-year-old woman presented 3 months after the birth of her third child with cough, bilateral pleuritic pain, and dyspnea. There was no history of previous illness, alcoholic abuse, or anovulatory drug self-administration. Routine ECG (Fig. 1) and chest x-ray examination performed 1 year prior to admission were normal. Physi&l examination revealed cyanosis, tachycardia, elevated jugular venous pressure, and hepatomegaly. Present were hypoxemia, hypocapnia, and ECG findings of right heart strain (Fig. 2). A pulmonary perfusion-ventilation scan showed multiple and bilateral filling defects. Gynecologic examination, upper abdomen ultrasound record, lower limbs, and pelvic venography were normal. M-mode and

DIAGNOSIS OF PELVIC VARICOSITIES IN WOMEN WITH CHRONIC PELVIC PAIN

45 women with a history of lower-abdominal pain of more than 6 months' duration for which no obvious cause had been found during laparoscopy (pelvic-pain syndrome) were investigated with transuterine pelvic venography. For comparison venography was carried out on 10 women in whom pathology was considered to be a likely cause for their pain and 8 women admitted for tubal ligation and who had no pain. Pelvic varicosities and congestion unrelated to parity or the menstrual cycle were commonly found in women with the pelvic-pain syndrome. A score for quantifying the severity of the pelvic vascular abnormalities has been devised; a value of 5 or more gave a diagnostic sensitivity of 91% and a specificity of 89% for the pelvic-pain syndrome.

New Techique for Pelvic Venography during Ascending Phlebography.

New Techique for Pelvic Venography during Ascending Phlebography.

New technique for pelvic venography during ascending phlebography.

A technique of pelvic venography making it possible to obtain satisfactory opacification of the iliofemoral segment of the pelvic veins consistently during ascending phlebography is described. The main features are the compression of the inferior vena cava with a compression band and balloon, and the use of a large amount of contrast material.

Pelvic venography.

Pelvic venography.

Preinguinal Canal Herniation of the Ureter

A 60-year-old man with a ten-year history of repeated attacks of left flank pain radiating to the left inguinal area was admitted to the hospital. An intravenous urogram and retrograde pyelogram substantiated the presence of a left ureteral herniation. Pelvic venography and arteriography proved that the ureter was not in a retroiliac vascular position. Repair of this extraperitoneal, congenital ureteral herniation required resection of the ureter and reanastomosis to the bladder. Follow-up revealed a normal left urinary tract with complete relief of symptoms.

Visceral pelvic venography in carcinoma of the cervix.

The anatomy of the visceral pelvic veins is described and the filling pattern during retrograde ovarian venography is illustrated. Six patients with Stage I carcinoma of the cervix had normal venograms. Two patients with lateral extension of tumor into the parametrium showed obstruction of the lower uterine veins.

Postoperative pelvic lymphocysts.

POSTOPERATIVE PELVIC LYMPHOCYSTSGERALD D. DODD, M.D., FELIX RUTLEDGE, M.D. and SIDNEY WALLACE, M.D.Audio Available | Share

Portal venous system as a major collateral in iliac and inferior vena caval obstruction.

Inferior vena cavography is frequently performed in conjunction with excretory urography and lymphangiography for the evaluation of intra-abdominal or retroperitoneal masses. Collateral circulation occurs in intrinsic obstruction with thrombosis or extrinsic compression of the inferior vena cava. Although frequently mentioned, the portal venous system as a major collateral in lower inferior vena caval obstruction is not commonly visualized at cavography. The purpose of this communication is to report two cases in which the portal venous system was visualized as a principal collateral route. Case I (T. S.): This patient was a 60-year-old white female, gravida V, Para 2, who had Stage IV epidermoid carcinoma of the cervix with urinary bladder involvement in December 1959. She was treated with intracavitary radium (3,000 mg hr.) followed by external radiation of 3,994 R/t/4 wk. The patient returned in February 1961 with recurrent tumor which was treated by an anterior pelvic exenteration and bilateral ureterosigmoidostomy. The patient did well until April 1962 when she was readmitted with a four-month history of swelling of both lower extremities and pubic region, pain in the right hip and thigh, intermittent low backache, and recurrent chills and fever. On admission, pelvic venography showed obstruction of both common iliac veins and a pelvic mass of a conglomeration of veins which subsequently opacified the inferior mesenteric vein and the portal venous circulation (Fig. 1). The patient died on Sept. 12, 1962, from generalized carcinomatosis. Case II (A.M.): This 24-year-old gravida IV, Para 4, Negress had profuse vaginal bleeding in December 1964. The patient had a Stage I epidermoid carcinoma of the cervix. She was treated with intracavitary radium (3,500 mg hr. in April 1965 and an additional 3,500 mg hr. in May 1965). External radiation (3,500 R/t/4 wk.) was administered via split ports to the pelvis. In November 1965 the patient complained of frequency of bowel movements and blood-tinged stool, urgency, and dysuria. Barium-enema examination on December 1965 revealed a rectosigmoid stricture. A transverse colostomy was performed. Exploration of the abdomen at this time did not disclose any tumor. In December 1966 right lower extremity edema and pain developed, radiating down the right leg. Biopsy of the uterine cervix at this time showed recurrent epidermoid carcinoma. Pelvic venography on Dec. 15, 1966, demonstrated obstruction of both common iliac veins. A mass of venous plexus was seen in the pelvis with subsequent opacification of the inferior mesenteric vein and the portal venous system (Fig. 2). This phenomenon was observed when 60 cc of methylglucamine diatrizoate was rapidly injected into the right femoral vein. The inferior mesenteric vein was not opacified when 40 cc of contrast material was manually injected into the left femoral vein. In both examinations, the vertebral plexus of veins was well demonstrated.

Evaluation of retrograde pelvic venography.

CONTRAST roentgenography of the large pelvic veins and the inferior vena cava was performed on 371 patients in the Mallinckrodt Institute of Radiology between 1958 and 1963 in an attempt to locate diseased lymph nodes, particularly those containing cancer. This study was undertaken to define the effectiveness of this radiological technique and the frequency of complications associated with it. The data indicate that this examination has little diagnostic value and is associated with a significant incidence of serious complications. Methods and Material The illnesses of the patients in whom venograms were performed are listed in Table 1. The venograms were made during the simultaneous injection of 50% diatrizoate sodium (Hypaque) through small intravenous catheters into both common femoral veins. Local anesthesia was used to introduce the catheters percutaneously. Results The majority of the patients examined had carcinoma of the cervix. The correlation of the venographic diagnoses and operative findings is

A COMPARISON OF THE DIAGNOSTIC ACCURACY OF LYMPHOGRAPHY, CAVOGRAPHY AND PELVIC VENOGRAPHY.

Lymphography, cavography and pelvic venography were carried out in a series of 32 patients with suspected pathology in lumbar or pelvic lymph nodes. The diagnostic information obtained from each procedure has been described and the advantages of lymphography over the other procedures demonstrated.

Effect of radiation on metastatic pelvic lymph nodes judged by pelvic venograms.

The proper management of any neoplasm depends upon accurate determination of its full extent. This applies not only to the primary lesion, but to metastases as well. While lymph-node metastases from some tumors lend themselves to inspection and palpation, node involvement from pelvic organs may remain hidden. Because of the frequency with which these pelvic nodes are involved, therapy has often been directed to include them even though in an individual case their true status is obscure. Metastatic lymph nodes can be demonstrated by distortion of the opacified pelvic venous system (1–3). Demonstration of such metastases is not only of value prognostically but contributes to proper management of the neoplasm. Since many pelvic tumors are treated by irradiation, it should then be possible to use pelvic venography to disclose the effects of radiation on the metastatic nodes. The draining lymph nodes from the pelvis lie along vascular channels, viz., the hypogastric and the external and common iliac vessels, t...

Retrograde Pelvic Venography

Retrograde Pelvic Venography

Limb Edema of Pelvic Etiology in Women: Its Evaluation by Means of Pelvic Venography and a Lymphatic Function Test

Limb Edema of Pelvic Etiology in Women: Its Evaluation by Means of Pelvic Venography and a Lymphatic Function Test