A's Mommy's MRI with Dr. Potter

[A's Mommy]

MRI of the pelvis

MRI of the pelvis was performed utilizing coronal fast inversion recovery, followed by coronal, sagittal, axial and oblique axial fast spin echo techniques followed by postcontrast axial fat suppressed oblique axial T1-weighted sequencing. Concern is pudendal nerve entrapment, particularly on the left. The patient by history has undergone laparoscopy and hysteroscopy to remove adhesions as well as correction of the uterus from a septate to a now arcuate configuration.

Sagittal images demonstrate post-traumatic deformity of the coccyx, with angulation such that the tip extends posteriorly and somewhat asymmetric to the left. There is linear scar formation surrounding the posterior margin of the rectosigmoid junction that extends towards the branch of the pudendal nerve towards the rectum. In the pelvic floor, there is also scarring of the anterior margin of Alcock's canal, which surrounds perivaginal fat planes, left greater than right. Following contrast administration, there is only mild enhancement.

Of additional note is marked prominence of pelvic floor venous plexus, indicative of pelvic floor varices which may correlate to pelvic venous congestion syndrome. The lack of inherent fat in the lower pelvis combined with the pelvic floor varices efface the fat planes of the pudendal nerve.

Coronal images more anteriorly demonstrate intact appearance of the genitofemoral and ilioinguinal nerves. Similarly, the obturator nerves demonstrate intact perineural fat plane throughout the field of view.

There is no pelvic adenopathy. The pelvic floor muscles appear symmetric bilaterally without disproportionate atrophy. Posteriorly, the sciatic nerves are symmetric. The fat planes surrounding the presacral plexus are unremarkable.

Mild resorption of the inferior margin of the pubic symphisis is seen, reflecting the effects of childbirth. There is no dehiscence of the rectus abdominus aponeurosis.

Moderate amount of free fluid is seen in the cul-de-sac. There is a dominant left adnexal cyst that is not individually enlarged by size criteria.

Impression:

MRI of the pelvis demonstrates findings consistent with pelvic venous congestion syndrome with marked distension of the pericervical venous plexus, impinging on the pudendal nerves of the pelvic floor but with additional perineural scarring of the anterior margin of Alcock's canal, left greater than right. Further, there is post-traumatic deformity of the tip of the coccyx, with mild scar surrounding the rectal fat planes, as outlined above.

[HerMajesty]

A's Mommy, If you are still in PT or can make a visit back to your PT, I would suggest you call this video to her attention: http://www.youtube.com/user/JERRYHESCH# ... YIZU_jltgg It shows a simple manual treatment for a side bent coccyx. If you listen carefully, at some point in the video he comments on how a side bent coccyx would impact the pelvic floor muscles; it would be interesting to see if this correlates with the assymetric spasticity you have mentioned.

[A's Mommy]

Wow, HerMajesty, VERRRY INTERESTING!!!

All my PTs and Docs to date haven't had much to say about my fractured coccyx. They said a lot of women have it from vaginal childbirth. I really wonder if this is truly contributing to some of my pain as well. I will bring it to my PT (when I go back to PT someday, haha).

I'd love to come to Las Vegas and see Dr. Hesch. Between the appointments, I could go eat at some of those awesome buffets I hear they have in Vegas. Or catch an Elvis show!

Sincerely,
A's Mommy

[HerMajesty]

Take it from a refugee from the East coast: The food at the buffets sucks, there is just a lot of it.
But we do have our Elvis and our Hesch (who is an MHS, PT, not a Dr...he doesn't fake it like SOME "Doctors" who pop up on pudendal sites, LOL), and you are always welcome

[kathyd]

Hi A's Mommy,
I too have had an MRI from Dr. Potter suggesting Pelvic Congestion Syndrome. I'm wondering if you ever looked into having it treated? I'm considering going to see Dr. Conway about PN but in my case some of my symptoms line up more with the pelvic congestion than the PN. The embolization seems to be a much less invasive treatment with a much quicker recovery. My husband feeels that the congestion is the cause of my pain and I hope he's right. I see many of the posts here mentioning varices but it doesn't sound like anyone had had them treated and I'm wondering why.
Thanks,
KathyD

[Griff522]

Kathy, I would be interested to know the treatment for varices also. I had them on my MRI too but she said they weren't significant.

[A's Mommy]

Hi Kathy and Griff--

I did have major pelvic varices as noted on my 3T MRI. Dr Potter recommended coil embolization, which I had done approximately 2 weeks after my MRI, here in my hometown. An interventional radiologist put titanium coils into my ovarian veins so no more blood could dilate them, thus rendering them ineffective from that point on. I had a follow up procedure done 3 weeks after that where the same doctor looked at my iliac veins and he said they were not congested and so therefore he did not have to use his intended treatment, which was to be injection of a sclerosing agent (a medication that causes the veins to pretty much collapse and die). Since my PN pain was not improved at all, we proceded to consult with a PN specialist, in this case, Dr Hibner. He is also very proficient and interested in Pelvic Congestion Syndrome--- he told me it is one of his areas of expertise. I believe in some cases he uses the DaVinci Robot to remove the ovarian veins completely. This has no effect on fertility.

Best regards,

AthenasMommy

[kathyd]

Dear Griff & A's Mommy,
Thanks for your responses. Oddly enough, I spoke to Dr. Conway today (we are considering going to see him regarding my possible PN) and told him about my considerable varices and he basically discounted them as a source of my issues. It's interesting to hear that Dr. Hibner does consider congestion to be important. On my latest MRI (Dec. 2010) Dr. Potter said that they were abutting my pudendal and dorsal nerves and even extending into my Alcock's Canal. My symptoms are urinary urge and frequency going back over 4 years and sit pain over the last two years. My symptoms always worsen as the day goes on. I did go to an interventional radiologist in Sept of 2009 after an earlier MRI showed the congestion. He did a vaginal ultrasound while I was standing and said that the varices were "stunning" and I had "found my answer". However, when he did the veinogram at the beginning of the embolization he saw no varices so he didn't continue. After finding the congestion again on the recent MRI, my husband wants me to see another radiologist. He thinks that it may not have shown on the veinogram because it was done in the morning and I had been lying on a hospital bed for a couple of hours prior to the procedure. Basically that I hadn't really been on my feet at all that day so the blood didn't have a chance to pool. We're looking for another radiologist now. I'll keep you posted.
Thanks,
KathyD

[Griff522]

Thanks for sharing AM and Kathy.

You know what bothers me? The fact that doctors seem to know more about male health problems. My son's pediatrician found a varicocele when he was 11 and he was referred to a pediatric urologist. He confirmed that it was large enough to cause future problems and we scheduled a date for outpatient surgery. A week later he was a happy, healthy boy.

[Karyn]

You know what bothers me?

Oddly enough, I spoke to Dr. Conway today (we are considering going to see him regarding my possible PN) and told him about my considerable varices and he basically discounted them as a source of my issues. It's interesting to hear that Dr. Hibner does consider congestion to be important. On my latest MRI (Dec. 2010) Dr. Potter said that they were abutting my pudendal and dorsal nerves and even extending into my Alcock's Canal.

As a patient of Dr. Conways, I think he's a very nice man, BUT - he seems to discount an awful lot. Did he happen to share his feeling with you about Dr. Potters MRI, Kathy? I don't think being closed minded is very helpful. The conjestion may not be the source of your issues but how could it not be a contributing factor?
I hope treating the varices does solve your problem. Any idea what your next step will be?
Warm regards,
Karyn