Presentation
Pelvic pain and heavy menses.
Patient Data
Multiple venous varicosities in the adnexa, more on the left side, extending into the uterus drained by a dilated left ovarian vein arising form the left renal vein. This is secondary to compression of the left renal vein by the SMA and aorta (nutcracker syndrome).
Case Discussion
The case typically presents the appearance of pelvic congestion syndrome with multiple dilated adnexal venous varicosities extending to the uterus and drained by a dilated left gonadal vein. In this case, it's important to carefully check the left gonadal and renal veins all through their courses to assess for any possible cause impeding their flow, like the nutcracker syndrome in this case in which the left renal vein is significantly compressed between the SMA and the aorta.
Pelvic congestion syndrome is considered the female homologue to testicular varicocele. It may be caused by:
venous obstruction: such as retroaortic left renal vein
compression of left renal vein by SMA also known as nutcracker phenomenon
incompetent valves in ovarian vein
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