[Uterine phlebography in pelvic venous stasis]

Area of Science:

• Vascular imaging
• Gynecologic imaging
• Pelvic venous disorders

Background:

• Pelvic venous stasis is a significant cause of pelvic pain.
• Accurate diagnosis of venous abnormalities is crucial for effective treatment.
• Hysterophlebography offers a method to visualize the venous system of the uterus.

Purpose of the Study:

• To evaluate the utility of hysterophlebography in diagnosing pelvic venous stasis.
• To describe the normal and pathological findings of uterine venous drainage.
• To correlate hysterophlebographic findings with pelvic pain etiology.

Main Methods:

• Hysterophlebography was performed to opacify pelvic veins.
• Contrast medium was injected to visualize the intrauterine and extrauterine venous networks.
• Images were analyzed for venous dilation, stasis, thrombosis, and emptying times.
• Proclive radiography in an upright position was used to enhance stasis visualization.

Main Results:

• Normal venous drainage showed rapid emptying (<10 seconds) via arcuate and uterine/lumbo-ovarian pedicles.
• Pathological findings included dilated intrauterine veins, thrombosis (9/10 left-sided), and delayed emptying (>20 seconds).
• Extrauterine stasis showed preferentially right-sided pedicle dilatation at the broad ligament base, with slow emptying.

Conclusions:

• Hysterophlebography is a valuable tool for diagnosing pelvic venous stasis and associated uterine abnormalities.
• The technique effectively differentiates normal venous patterns from pathological stasis, including thrombosis.
• Findings correlate with the pathophysiology of vascular pelvic pain, guiding potential therapeutic strategies.