Ultrasound diagnosis of round ligament varices in pregnancy

Abstract

Varicose veins of the round ligaments during pregnancy are rare with only 16 reported cases in literature in the last 65 years [1]. It can easily be mistaken for an inguinal hernia. Anatomically, the round ligament extends from the lateral uterus to the labium majorus containing veins, arteries, lymphatic channels, and nerves. Round ligament varices are prominent veins within the round ligament and are more common in pregnancy because pregnancy promotes increased venous flow and decreased venous tone [2]. During physical examination, it is difficult to differentiate between round ligament varicosity and inguinal hernia.

A 29-year-old woman, in the 30th week of pregnancy, presented to the emergency department with a complaint of a small, painless palpable left groin mass. The surgeon's clinical diagnosis was inguinal hernia and she was referred to the radiology department for diagnostic ultrasound. Doppler sonography showed an asymmetric left inguinal mass composed of multiple anechoic tubular ducts (Figure 1) with a venous flow pattern (Figure 2), consistent with round ligament varices. The patient was treated conservatively without any complication in pregnancy.

The diagnosis of varicosities of the round ligaments can be made on grayscale and color Doppler sonography [2]. Rapid identification and diagnosis of round ligament varices are important to avoid unnecessary surgical treatment. Ultrasound is the gold standard for the diagnosis with a classic gray-scale ultrasound image of a “bag of worms” appearance associated with varicose veins and a venous flow pattern on Doppler imaging [3].

Dragan Vasin: Conceptualization (lead); investigation (equal); visualization (equal). Danijela Sekulić: Conceptualization (equal); investigation (equal); software (equal).

There are no conflicts of interest to declare.

Not applicable.

Authors obtained inform patient consent.