Pelvic congestion syndrome (PCS) is an uncommon illness that is typically diagnosed after chronic pelvic pain. We present a case of superficial thrombosis of pelvic veins from PCS that presented to the emergency department (ED) as a previous diagnosis of pelvic abscess with cellulitis. PCS was diagnosed in the ED by computed tomography after an abnormal point-of-care ultrasound. Here we describe this unusual presentation and our approach to the diagnosis.