Venous reflux from the pelvis and vulvoperineal region as a possible cause of lower extremity varicose veins: diagnosis with computed tomographic and ultrasonographic findings.
OBJECTIVE
The aim of this study was to demonstrate with the use of computed tomography and ultrasonography that isolated venous reflux from the pelvis and vulvoperineal region is a possible cause of lower extremity varicose veins.


METHODS
From a consecutive series of patients who were referred to the vascular imaging laboratory, we retrospectively selected patients who had unusual lower extremity varicose veins that arose from the pelvis and vulvoperineal region. Computed tomographic venography and ultrasonograhy were used to exclude other causes of varicose veins. We reviewed medical records to evaluate the presence of pelvic congestion syndrome. Computed tomographic findings were reviewed to locate ovarian vein dilatation.


RESULTS
Twenty limbs of 15 female patients (age range, 33-72 years; mean age, 53.2 years) were diagnosed with varicose veins that arose from the pelvis and vulvoperineal region without any saphenofemoral insufficiency. Eleven patients (73.3%) had no history of chronic pelvic pain. Four patients (26.7%) presented with chronic pelvic pain without any other evident gynecological etiology. Dilatation of the left ovarian vein was seen in 10 patients (67%; mean dilatation, 8.6 mm; range, 7.5-9.6 mm). Five patients (33%; mean dilatation, 4.9 mm; range, 3.8-6.6 mm) showed no ovarian vein dilatation.


CONCLUSIONS
The combined use of computed tomographic venography and ultrasonography may be a possible noninvasive method for the diagnosis of unusual lower extremity varicose veins. Venous reflux from the pelvis and vulvoperineal region as a cause of lower extremity varicose veins can manifest without evidence of pelvic congestion syndrome or ovarian vein dilatation.
Jin
Kwang Nam
KN
Department of Radiology, Seoul National, University College of Medicine, 28, Yongon-dong, Chongno-gu, Seoul 110-744, Korea.
Lee
Whal
W
Jae
Hwan Jun
HJ
Yin
Yong Hu
YH
Chung
Jin Wook
JW
Park
Jae Hyung
JH
D000328:Adult; D000368:Aged; D004108:Dilatation, Pathologic / Q000150:complications / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply; D008875:Middle Aged; D010053:Ovary / Q000098:blood supply; D017699:Pelvic Pain / Q000209:etiology; D010388:Pelvis / Q000000981:diagnostic imaging; D010690:Phlebography / Q000379:methods; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D018608:Ultrasonography, Doppler; D014648:Varicose Veins / Q000000981:diagnostic imaging / Q000209:etiology*; D014680:Veins / Q000000981:diagnostic imaging; D014689:Venous Insufficiency / Q000150:complications / Q000000981:diagnostic imaging*