Eur Radiol DOI 10.1007/s00330-006-0440-x UROGENITAL Zafer Koc Serife Ulusan Levent Oguzkurt Received: 20 February 2006 Revised: 19 July 2006 Accepted: 10 August 2006 # Springer-Verlag 2006 Association of left renal vein variations and pelvic varices in abdominal MDCT Abstract The aim of this study was to determine whether left renal vein (LRV) variation is associated with pelvic varices and left ovarian vein (LOV) reflux. Routine abdominal multidetector-row computed tomog- raphy scans of 324 women without symptoms of pelvic congestion syn- drome were analyzed. Presence and type of LRV variants (circumaortic [CLRV] or retroaortic [RLRV]) were recorded. Diameters of the LRV, ovarian veins (OVs), and parauterine veins were measured and a specific LRV diameter ratio was calculated for each patient. Presence and severity of pelvic varices and LOV reflux were noted. Pelvic varices were detected in 59 (18%) of the total of 324 women, in 7 (37%) of the 19 women with RLRVs, in 7 (29%) of the 24 women with CLRVs, and in 45 (16%) of the 281 women with normal LRVs. The frequency of pelvic varices in the women with LRV variation was sig- nificantly higher than that in the group with normal LRV anatomy (33 vs. 16%; p=0.009). The frequency of pelvic varices in the women with RLRVs was also significantly higher than that in the group with normal LRV anatomy (p=0.02). LRV diameter ratio was correlated with presence of pelvic varices and presence of LOV reflux (p=0.0001 for both). This study revealed an association between pel- vic varices and LRV variations in a population of predominantly multipa- rous women. Keywords Retroaortic . Circumaortic . Renal vein variation . Pelvic varices . Computed tomography Introduction Pelvic congestion syndrome (PCS) is an important cause of chronic pelvic pain in women. This condition is character- ized by persistent dull pelvic pain that worsens in the premenstrual period [1–3]. Multiparous women of child- bearing age are most often affected, and the typical imaging findings are dilatation of the ovarian veins and parauterine veins [1, 3, 4]. Reflux from the left renal vein (LRV) into the left ovarian vein (LOV) is thought to contribute to the development of PCS and the formation of pelvic varices [3, 5]. Retroperitoneal venous variants may be related to obstruction of the gonadal outflow and cause pelvic varices [6]. Embryologically, the LRV is formed from a circum- aortic venous ring. In normal development, this vein forms ventral to the aorta when the retroaortic limb of this circumaortic venous ring regresses. The retroaortic left renal vein (RLRV) variant arises when the retroaortic limb persists and the preaortic limb regresses, whereas the circumaortic left renal vein (CLRV) variant arises when both limbs persist [7–9]. In this study, we used the term LRV variation to indicate RLRVand CLRV because these two forms comprise nearly all LRV variants in humans [10, 11]; no other types of LRV variants were detected in our series. Variant venous anatomy in the abdomen can lead to venous obstruction, and thus may contribute to PCS. The most common variations of LRV are CLRV and RLRV, with reported prevalence rates of 2.4 to 17% and 1.7 to 3.4% respectively [7, 10, 12]. Research has shown that The preliminary results of this study were presented as an electronic poster at the ECR (European Congress of Radiology) confer- ence, 3–7 March 2006 in Vienna, Austria. Z. Koc . S. Ulusan . L. Oguzkurt Adana Teaching and Medical Research Center, Department of Radiology, Başkent University, Adana, Turkey Z. Koc (*) Başkent Universitesi Adana Hastanesi, Dadaloğlu Mah. Serin Evler 39. Sok. No: 6 Yüreğir, Adana, Turkey e-mail: koczafer@gmail.com Tel.: +90-322-3272727 Fax: +90-322-3271270