Evaluating the frequency and severity of ovarian venous congestion on adult computed tomography

Purpose: While pelvic congestion syndrome and chronic pelvic pain are relatively common in women, no large- or medium-sized studies have been conducted to our knowledge to evaluate the frequency and severity of ovarian vein dilatation (OVD) on computed tomography (CT). The purpose of our study was therefore to analyze a large number of consecutive abdominal and pelvic CT scans in adult women to determine OVD frequency and severity. Methods: An IRB-approved, single-institution retrospective analysis of 1042 consecutive abdominal and pelvic CT scans in women ages 25–65 was performed. Scans were evaluated for the presence and severity of OVD and association with “nutcracker anatomy.” A gradation scheme was developed based on quartile analysis. Results: 143 of the CT scans had OVD (13.7%). Of the positive scans, 96 were bilateral, 29 were left-side only, 18 were right-side only, and 18 had nutcracker-type compression of the left renal vein (14.4% of scans with left or bilateral OVD). In positive scans, the mean and median left OVD were 7.5 and 7 mm, respectively, and right-side were 7.2 and 7 mm, respectively. Based on quartile analysis, OVD grading was mild (< 6 mm), moderate (6–8 mm), or severe (> 8 mm), with moderate including the middle 50% of patients. Conclusions: OVD was found on 13.7% of 1042 consecutive female abdominal and pelvic CT scans, with “nutcracker anatomy” present in 14.4% of the scans with left OVD. Moderate dilatation was defined as an OVD of 6–8 mm at the iliac crests.