A narrative review to investigate ultrasound findings associated with female pelvic congestion syndrome.

Introduction: Female pelvic congestion syndrome is associated with chronic pelvic pain and affects approximately 30% of women. There are no formal diagnostic criteria to assist with the diagnosis of pelvic congestion syndrome despite affecting such a large proportion of the population. Furthermore, the aetiology and anatomy of pelvic congestion syndrome has significant overlap with the causal factors of varicoceles in men, many of whom also experience chronic pain/aching. However, women are at greater risk of developing venous damage associated with pelvic congestion syndrome due to hormonal changes and pregnancy, both of which exacerbate pelvic congestion syndrome and its causes. Methodology: A narrative review methodology was utilised to search for literature discussing ultrasound and its role in the diagnosis of pelvic congestion syndrome. The search used two databases and explored 'grey' literature published between 2014 and 2024. Sensitivities and specificities of diagnostic criteria proposed have been reported as well as other metrics which may be utilised in the ultrasound diagnosis of pelvic congestion syndrome. Discussion: Ultrasound appearances associated with pelvic congestion syndrome include dilated pelvic veins, specifically; the left ovarian vein, adnexal veins, and intrauterine/myometrial veins. There are, however, few high-quality comparative studies assessing the accuracy of different venous diameter cut-off values which may be used in the diagnosis of pelvic congestion syndrome. Other ultrasound findings cited commonly include slow venous flow of less than 3 cm per second and demonstrable venous reflux on Valsalva manoeuvre. Conclusion: Currently there are insufficient data to conclude formal diagnostic ultrasound criteria for pelvic congestion syndrome. Existing evidence supports a multifaceted diagnostic approach and ultrasound practitioners must be mindful of patients' clinical history and potential associated ultrasound features to avoid underdiagnosis of this common condition. In the meantime, further primary research is needed before the full value of ultrasound can be understood.