Background: Chronic Pelvic Pain (CPP) is a common complaint in women, and is the key factor in the diagnosis of Pelvic Congestion Syndrome (PCS). Introduction: Consecutive abdominal and pelvic Computed Tomography (CT) scans in adult female patients not diagnosed with PCS and collected over a period of 3 years were evaluated retrospectively to determine the prevalence of underestimated Pelvic Congestion (PC). Methods: 500 consecutive abdominal and pelvic CT scans collected from female patients aged 18-80 years were retrospectively analyzed for the presence of PC. Results: 90 of the CT scans examined showed the presence of PC (18%). These patients were divided into two groups: Group I had 52 scans with unilateral PC, while Group II had 38 scans with the bilateral enlarged Ovarian Vein (OV). Left and right OV diameters were measured as 7.14 +/- 2.15 and 5.56 +/- 1.87 mm, respectively. Co-occurrence of additional vascular anomalies, such as nutcrack er-type compression of the left renal vein, and May Thurner, was significantly higher in Group I than Group II (p<0.001). The diameter of the OV remained wide irrespective of age in Group I, but showed a decrease with increasing age in Group II. The most common complaint was abdominal pain; these patients required an average of six referrals to two different clinics (primarily general surgery and internal medicine) before being diagnosed with PC. Conclusion: The diagnosis of PCS remains to be an important problem for patients because of insufficient perception of physicians. PCS should be considered in female patients with complaints of chronic abdominal and pelvic pain and CT may be a valuable examination tool for diagnosis.