Pelvic Congestion Syndrome Presenting with Massive Pulmonary Embolism

Pelvic Congestion Syndrome (PCS) causes chronic pelvic pain due to incompetent, dilated pelvic veins. Inferior Vena Cava (IVC) thrombosis can either be a cause or effect of PCS. Pulmonary embolism in such a setting is rare with only a few reported cases till date. A heightened awareness and clinical suspicion for the specific symptomatology and associated findings are necessary to prevent catastrophe. This report is about a rare case in a young multiparous female with overlooked chronic pelvic pain, due to PCS presenting with breathlessness and hypotension. On evaluation, her echocardiogram revealed dilated right sided chambers, large thrombus in IVC and right pulmonary artery. Troponin was elevated. Computed Tomography (CT) scan confirmed massive pulmonary embolism along with presence of dilated pelvic plexus and dilated right ovarian vein. Patient was successfully treated with systemic thrombolysis followed by oral anticoagulation.