Pelvic congestion syndrome (PCS) is a cause of chronic pelvic pain in women, defined as pelvic pain lasting for more than six months. Diagnosis is challenging due to varied causes such as endometriosis, adhesions, chronic PID, ovarian cysts, fibroids, and pelvic varicosities. Radiology plays a key role, including PUS, TVS with Doppler, MRI, CT, and ovarian venography. We report a case of a 35-year-old multiparous woman diagnosed with PCS based on typical TVS and Doppler findings. © 2014 Elsevier B.V., All rights reserved.