What is the significance of ovarian vein reflux detected by computed tomography in patients with pelvic pain?

Chronic pelvic pain (CPP) is a common gynecological complaint. CPP is nonmenstrual pain localized in the anatomic pelvis of at least 6 months' duration without any identifiable organic cause that is severe enough to cause functional disability and require treatment. Pelvic congestion syndrome (PCS) is a poorly understood disorder and often overlooked cause of pelvic pain. Ovarian vein reflux (OVR) and pelvic varicosities are a cause of PCS. On the other hand, OVR can be seen in asymptomatic women, typically parous. OVR has a characteristic appearance at enhanced computed tomography (CT). Contrast medium retrogradely fills the ovarian veins and parauterine veins during the arterial phase after intravenous contrast administration. CT is not the ideal modality to evaluate all the causes of pelvic pain, but CT is a commonly used diagnostic modality to screen patient who presents with abdominal and pelvic pain. CT can demonstrate abnormal ovarian venous flow as well as tortuous and dilated ovarian and pelvic veins. Ovarian vein reflux is important to recognize and when correlated with patient clinical presentation may help in the diagnosis of PCS.