A 33-year-old woman arrived at our emergency department for an exacerbation of chronic pelvic pain (pain was determined with the numeric rating scale [from 0 to 10] with a value of 8). She had 2 pregnancies, and after the second pregnancy (4 years ago) she began to manifest debilitating chronic noncyclic lower pelvic pain, generally with worsening of symptoms at the end of the day. On clinical examination she presented with vague symptoms of lower pelvic pain with no palpable abdominal masses. She underwent abdominal contrast-enhanced multidetector computed tomography with coronal volume-rendering technique vascular reconstruction that demonstrated a dilated left ovarian vein with a retrograde filling of intravenous contrast medium during the arterial phase (Fig. 1). This radiologic sign was indicative for venous incompetence, and a diagnosis of second grade multidetector computed tomography of pelvic congestion syndrome was done [1Tadao Hiromura T. Nishioka T. Nishioka S. Ikeda H. Tomita K. Reflux in the left ovarian vein: analysis of MDCT findings in asymptomatic women.AJR Am J Roentgenol. 2004; 183: 1411-1415Crossref PubMed Scopus (58) Google Scholar]. The patient began medical treatments with medroxyprogesterone acetate (orally 30 mg/day) for 6 months with minimal relief from symptoms, despite fully complying with this treatment. Therefore, in an elective regimen, she underwent selective digital subtraction angiography of the left ovarian vein that confirmed its dilatation with inversion of flow (Fig. 2) with consequent embolization. Follow-up at 24 months after transcatheter embolization, without long-term medical treatments, revealed absence of pelvic symptoms and reduction of uterus left vein congestion. Chronic pelvic pain is generally difficult to diagnose and treat, because of its wide range of possible causes with overlapping symptoms in young and elderly patients. This is due to lack of evidence-based diagnostic criteria and for treatment guidelines this condition. One of the possible causes of chronic pelvic pain is pelvic congestion syndrome, characterized by incompetence of the ovarian vein valves with consequent retrograde venous flow and engorged veins [2Zondervan K.T. Yudkin P.L. Vessey M.P. et al.Chronic pelvic pain in the community—symptoms, investigations, and diagnoses.Am J Obstet Gynecol. 2001; 184: 1149-1155Abstract Full Text Full Text PDF PubMed Scopus (180) Google Scholar]. Treatment options include pharmacologic, percutaneous transcatheter vein embolization, and surgery/laparoscopy [3Stones R.W. Pelvic vascular congestion—half a century later.Clin Obstet Gynecol. 2003; 46: 831-836Crossref PubMed Scopus (38) Google Scholar]. After careful patient selection and multidisciplinary discussion among several specialist figures (surgeons, gynecologists, and interventional radiologists) [4Rossi U.G. Torcia P. Cariati M. Uterine arteriovenous malformation.Vasc Med. 2016; 21: 473-474Crossref PubMed Scopus (2) Google Scholar], transcatheter embolization can be a valid therapeutic option in the management for symptomatic ovarian vein incompetence cases that do not respond to medical therapy [5Black C. Thorpe K. Venbrux A. et al.Research reporting standards for endovascular treatment of pelvic venous insufficiency.J Vasc Interv Radiol. 2010; 21: 796-803Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar].