Haikun Yang,1,2,* Yan Zhang,3,* Wen He1,4 

1Meizhou Clinical Institute, Shantou University Medical College, Meizhou, Guangdong Province, People’s Republic of China; 2Department of Gynaecology, Meizhou People’s Hospital, Meizhou, Guangdong Province, People’s Republic of China; 3Department of Radiology, the First People’s Hospital of GuiYang, Guiyang, Guizhou Province, People’s Republic of China; 4Meizhou Academy of Medical Sciences, Meizhou People’s Hospital, Meizhou, Guangdong Province, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Wen He, Email doctorhoman@163.com

Abstract: Pelvic congestion syndrome (PCS) is a chronic condition primarily characterized by pelvic pain and heaviness, with vaginal bleeding being a rare but significant symptom. We present two cases of PCS-related vaginal bleeding, emphasizing the necessity of considering PCS in differential diagnoses for abnormal vaginal bleeding. A 28-year-old Chinese woman presented with abnormal vaginal bleeding exacerbated by abdominal pressure during activities like squatting or defecation. Imaging revealed a dilated right ovarian vein, and transcatheter venography confirmed Nutcracker syndrome. After undergoing transcatheter foam sclerotherapy, her symptoms resolved. The second case involves a 29-year-old Chinese woman with similar symptoms; imaging and venography identified a dilated left ovarian vein. Following sclerotherapy, her symptoms also alleviated. These cases underscore the importance of recognizing PCS as a potential cause of abnormal vaginal bleeding and demonstrate the efficacy of transcatheter foam sclerotherapy in managing this condition. Integrating clinical presentation with imaging findings is crucial for timely diagnosis and effective treatment, ultimately improving patient outcomes.

Keywords: pelvic congestion syndrome, vaginal bleeding, transcatheter foam sclerotherapy, nutcracker syndrome