Olga M. Kalinkin MD, Abstract Co-Author: Nothing to Disclose

Rohit Khanna MD, Presenter: Nothing to Disclose

Diana Atashroo MD, Abstract Co-Author: Nothing to Disclose

Andrea Chen MD, Abstract Co-Author: Nothing to Disclose

Michael Hibner MD, PhD, Abstract Co-Author: Nothing to Disclose

Pudendal neuralgia is a painful condition with poorly understood etiology. Dilated vessels accompanying the pudendal nerve in anatomically narrowed spaces may cause extrinsic mass effect on the nerve. We are evaluating the presence of pelvic venous congestion in the patients with pudendal neuralgia.

A retrospective analysis of the dedicated contrast enhanced pelvic MRI examination performed for 146 female patients with pudendal neuralgia clinically assessed by pelvic surgeons specialized in treatment of pudendal neuralgia. Diameter and localization of dilated venous vessels along the course of pudendal nerve in the interligamentous space, Alcock’s’ canal, at the inferior rectal branch, perineal branch, dorsal clitoral branch, caliber of vessels of the parauterine or paravaginal (in case of hysterectomy) venous plexus were assessed. Correlation of type of pelvic venous congestion with clinical symptom laterality was performed.

Among 146 female patients, 81 patients (55%), aged from 26 to 79 years, were found to have dilated venous pelvic vessels. Supralevator pelvic venous congestion is identified as dilatation of parauterine or paravaginal venous plexus without or with focally dilated vessels along the course of pudendal nerve in 34 and 28 patients respectively. Infralevator pelvic venous congestion as isolated dilated vessels in Alcock’s canal or interligamenous space and focally dilated small branches of pudendal nerves was seen in 13 patients and 6 patients respectively. 57 patients (90%) with supralevator pelvic venous congestion have bilateral site of pain or bilaterality of physical exam findings. In 7 from 19 patients the presence of isolated dilated veins along the pudendal nerve in Alcock’s canal or interligamentous space (infralevator unilateral pelvic congestion) are not associated with laterality of pain or symptoms.

Spectrum of pelvic venous congestion in the female patients with pudendal neuralgia is ranging from diffuse supralevator parauterine (paravaginal) venous plexus dilatation to isolated infralevator focal venous dilatation of pudendal veins in Alcock’s canal or interligamentous spaces or small venous varices along the branches of pudendal veins.

Differentiation of supralevator versus infralevator pelvic venous congestion may guide the pelvic surgeon to select an appropriate treatment with gonadal vein ligation versus focal venosclerotherapy.

Kalinkin, O, Khanna, R, Atashroo, D, Chen, A, Hibner, M, Spectrum of Pelvic Venous Congestion in Pudendal Neuralgia in Female Patients.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13016843.html